Abstract
BackgroundIn this study, we evaluated the impact of obesity and/or overweight on the achievement of minimal disease activity (MDA) in patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA) receiving an anti-rheumatic treatment. Obesity can be considered a low-grade, chronic systemic inflammatory disease and some studies suggested that obese patients with rheumatic diseases exhibit a lower rate of low disease activity achievement during treatment with anti-rheumatic drugs.MethodsA systematic search was performed in major electronic databases (PubMed, Web of Science, Scopus, Embase) to identify studies reporting MDA achievement in obese and/or overweight patients with RA or PsA and in normal-weight RA or PsA control subjects. Results were expressed as Odds Ratios (ORs) with pertinent 95% Confidence Intervals (95%CIs).ResultsWe included 17 studies (10 on RA and 7 on PsA) comprising a total of 6693 patients (1562 with PsA and 5131 with RA) in the analysis. The MDA achievement rate was significantly lower in obese patients than in normal-weight subjects (OR 0.447, 95% CI 0.346–0.577, p < 0.001, I 2 = 62.6%, p < 0.001). Similarly, overweight patients showed a significantly lower prevalence of MDA achievement than normal-weight subjects (OR 0.867, 95% CI 0.757–0.994, p = 0.041, I 2 = 64%, p = 0.007). Interestingly, the effect of obesity on MDA was confirmed when we separately analyzed data on patients with RA and patients with PsA. In contrast, when we evaluated the effect of overweight, our results were confirmed for PsA but not for RA. A meta-regression analysis showed that follow-up duration, age, male sex, and treatment duration are covariates significantly affecting the effect of obesity/overweight on MDA achievement.ConclusionsThe results of our meta-analysis suggest that obesity and overweight reduce the chances to achieve MDA in patients with rheumatic diseases receiving treatment with traditional or biologic disease-modifying antirheumatic drugs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-016-1194-8) contains supplementary material, which is available to authorized users.
Highlights
In this study, we evaluated the impact of obesity and/or overweight on the achievement of minimal disease activity (MDA) in patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA) receiving an anti-rheumatic treatment
In the present meta-analysis, we evaluated whether obesity and overweight impact the clinical response in patients with PsA and patients with RA receiving treatment with traditional disease-modifying antirheumatic drugs (DMARDs) or biologic Disease-modifying antirheumatic drug (DMARD)
Search strategy To identify all available studies, a detailed search of studies reporting the achievement of minimal disease activity (MDA) in obese/overweight patients with RA/PsA and in normalweight control subjects was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines [20]
Summary
We evaluated the impact of obesity and/or overweight on the achievement of minimal disease activity (MDA) in patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA) receiving an anti-rheumatic treatment. Obesity can be considered a low-grade, chronic systemic inflammatory disease and some studies suggested that obese patients with rheumatic diseases exhibit a lower rate of low disease activity achievement during treatment with anti-rheumatic drugs. Some studies [17] suggested that obese patients with rheumatic diseases exhibit a lower rate of low disease activity achievement during treatment with antirheumatic drugs. These results were challenged and not confirmed by other studies [18, 19]. In the present meta-analysis, we evaluated whether obesity and overweight impact the clinical response in patients with PsA and patients with RA receiving treatment with traditional disease-modifying antirheumatic drugs (DMARDs) or biologic DMARDs
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