Weight Gain Threatens Remission in Rheumatoid Arthritis

Marcia Frellick

November 07, 2015

People with early rheumatoid arthritis who are overweight or obese are less likely than those of normal weight to achieve sustained remission over time, new research shows.

Including weight-management interventions in the treatment plans of these patients could improve quality of life and prevent joint damage, Elizabeth Schulman, MD, from the Hospital of Special Surgery in New York City, and colleagues report.

The study results will be presented November 8 during a news conference at the American College of Rheumatology 2015 Annual Meeting in San Francisco.

Dr Schulman's team evaluated 1006 patients from the multicenter Canadian Early Arthritis Cohort, known as CATCH, over a 3-year period.

They assessed body mass index (BMI) and time to sustained remission — defined as the time from first visit to the achievement of a Disease Activity Score in 28 joints (DAS28) of 2.6 or below at two consecutive visits.

Patients were categorized as normal weight (BMI, 18.5 - 24.9 mg/kg²), overweight (BMI, 25.0 - 29.9 mg/kg²), or obese (BMI, ≥30 mg/kg²).

Sustained Remission

There was no difference in time to remission among the three groups. However, overweight patients were 25% less likely to achieve sustained remission than normal-weight patients at 6, 12, 18, 24, and 36 months (hazard ratio [HR], 0.75; P = .03), and obese patients were 37% less likely at all time points (HR, 0.63; P = .0008).

Sustained remission was more likely in people who achieved a DAS28 of 3.2 or less at 6 months (HR, 4.21; P < .0001), in those with a higher education (HR, 1.61; P = .05), and in those who used methotrexate in the first 3 months (HR, 1.40; P = .02).

Conversely, those with more comorbidities were less likely to achieve sustained remission (HR, 0.91; P = .007), as were those who used steroids in the first 3 months (HR, 0.76; P = .01).

 
Treating early and really paying attention to these defined outcomes could keep patients in remission for a longer period of time.
 

"This is further evidence that treating early and really paying attention to these defined outcomes could keep patients in remission for a longer period of time," Dr Schulman told Medscape Medical News. "The goal in rheumatology is to treat patients early and to treat them to a target of at least low disease activity, if not remission."

The study also is further proof that the early use of methotrexate, the first-line disease-modifying agent for rheumatoid arthritis, can help get a patient to achieve and stay in remission, she said.

This news about obesity takes the benefit of controlling weight to another level: losing weight could make therapies more effective in early rheumatoid arthritis, said Elaine Husni, MD, MPH, director of the Arthritis and Musculoskeletal Treatment Center at the Cleveland Clinic.

 
Perhaps losing weight in this early time will optimize treatment even more. This sends a really important message to clinicians
 

"We're always talking about this window of opportunity in rheumatology, where we're trying to treat earlier and earlier," she told Medscape Medical News. "Perhaps losing weight in this early time will optimize treatment even more. This sends a really important message to clinicians."

Guiding patients in lifestyle modifications, exercise, and therapies are not necessarily part of the rheumatologist's training, so understanding the need to refer to primary care or endocrinology appropriately will become more important, she explained.

Dr Schulman and Dr Husni have disclosed no relevant financial relationships.

American College of Rheumatology (ACR) 2015 Annual Meeting: Abstract 3182. To be presented November 8, 2015.

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