Improved Outcomes in Rheumatoid Arthritis With Obesity After a Weight Loss Intervention

Randomized Trial

Veena K. Ranganath; Antonio La Cava; Sitaram Vangala; Jenny Brook; Tanaz A. Kermani; Daniel E. Furst; Mihaela Taylor; Gurjit S. Kaeley; Catherine Carpenter; David A. Elashoff; Zhaoping Li


Rheumatology. 2023;62(2):565-574. 

In This Article

Abstract and Introduction


Objective: To examine whether a weight loss intervention programme improves RA disease activity and/or musculoskeletal ultrasound synovitis measures in obese RA patients.

Methods: We conducted a proof-of-concept, 12-week, single-blind, randomized controlled trial of obese RA patients (BMI ≥ 30) with 28-joint DAS (DAS28) ≥ 3.2 and with evidence of power Doppler synovitis. Forty patients were randomized to the diet intervention (n = 20) or control group (n = 20). Diet intervention consisted of a hypocaloric diet of 1000–1500 kcal/day and high protein meal replacements. Co-primary outcomes included change in DAS28 and power Doppler ultrasound (PDUS)-34. Clinical disease activity, imaging, biomarkers, adipokines and patient-reported outcomes were monitored throughout the trial. Recruitment terminated early. All analyses were based on intent-to-treat for a significance level of 0.05.

Results: The diet intervention group lost an average 9.5 kg/patient, while the control group lost 0.5 kg (P < 0.001). Routine Assessment of Patient Index Data 3 (RAPID3) improved, serum leptin decreased and serum adiponectin increased significantly within the diet group and between the groups (all P < 0.03). DAS28 decreased, 5.2 to 4.2, within the diet group (P < 0.001; −0.51 [95% CI −1.01, 0.00], P = 0.056, between groups). HAQ-Disability Index (HAQ-DI) improved significantly within the diet group (P < 0.04; P = 0.065 between group). Ultrasound measures and the multi-biomarker disease activity score did not differ between groups (PDUS-34 −2.0 [95% CI −7.00, 3.1], P = 0.46 between groups).

Conclusion: Obese RA patients on the diet intervention achieved weight loss. There were significant between group improvements for RAPID3, adiponectin and leptin levels, and positive trends for DAS28 and HAQ-DI. Longer-term, larger weight loss studies are needed to validate these findings, and will allow for further investigative work to improve the clinical management of obese RA patients.

Trial Registration:,, NCT02881307


RA patients with obesity represent >30% of North American RA patients[1,2] and are less likely to attain remission[3–5] and optimal response to therapy than non-obese patients.[4–6] They also have evidence of more joint deformity, functional disability, decreased quality of life and increased cardiovascular risks than non-obese patients.[3,7,8]

Although clinicians advocate for weight loss because of substantive economic and public health concerns,[8–10] there is still a lack of definitive evidence about the effects of weight loss on RA disease activity. In this context, there are no standardized interventions for the reduction of obesity rates in RA patients. Exercise is considered safe[11] but a broad implementation of exercise regimens in RA patients is limited by fears of causing injury and/or aggravating disease, in addition to being highly variable in terms of weight loss results.[12–14] Data suggest that hypocaloric diets have been successful in producing weight loss and health benefits, and the World Health Organization recommends a minimum of 5% body weight loss in obese patients.[7,15,16] Yet, few studies have investigated the impact of weight loss in obese RA patients through dietary modifications,[17,18] and no studies have examined its impact comprehensively on RA disease outcomes (clinical, imaging and biomarker measures).

Here we report the results of a proof-of-concept, 12-week, randomized controlled trial (RCT) of a hypocaloric diet in RA patients with obesity to evaluate the effects of weight loss on clinical, imaging and biomarker/adipokine outcomes.