Impacto de la obesidad y su relación con la actividad de la enfermedad en pacientes con Artritis Reumatoide

Abstract

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by polyarticular synovial inflammation, with a worldwide prevalence of approximately 1%. Despite significant therapeutic improvements in controlling inflammation of patients with RA, there is a group of patients who don’t respond to treatment, and have greater risk of functional impairment, work disability and decreased quality of life. Obesity and being over- weight have been associated with worse outcomes, such as a lower probability of achieving satisfactory inflammatory and pain control and greater functional impairment in patients with RA. objective: To establish the clinical-epidemiological characteristics of RA patients with ob- esity, overweight and normal weight and describe the relationship with disease activity. Materials and methods: descriptive, analytical, cross-sectional study. We reviewed medi- cal records of patients who had been diagnosed with RA (according to ACR 1987 and ACR 2010 criteria) from 2010 to 2018, in regular follow-up in the Rheumatology department of Hospital de Clinicas, National university of Asuncion. A questionnaire was completed with epidemiological (ie sex, age, origin) and clinical variables (ie, disease duration, disease activity (DAS 28), patient medical history, comorbidities, laboratory (acute phase reactants, rheumatoid factor, ACPA) and radiographic data (erosions). Qualitative variables are ex- pressed in frequencies and percentages and quantitative variables are averaged with stan- dard deviation. Chi Square was used for qualitative variables and T-student for quantitative ones. The statistical analysis was carried out with the statistical program SPSS v.23.0. A p of <0.05 was considered statistically significant. Results: A total of 165 patients with a diagnosis of RA were included, of which 82.4% (135/165) were female. The average duration of the disease was 8.5 ± 8.4 years. Approxi- mately 76% (120/165) had a positive RF and 86.6% (97/112) were ACPA positive. Fifty four (44.6%) patients had erosions on X-Rays. The mean DAS 28 score was 3.55 ± 1.31. Almost 60% were on concomitant treatment with prednisone, with an average dose of 7.63 ± 4.9 mg/d. Forty percent (66/165) had obesity and 35.8% (59/165) were overweight. The average BMi was 28.7 ± 5.38. When comparing the different variables between obese and non-obese patients, we found that obese patients require a greater number of DMARDs (Obesity: 1.85 ± 0.685 vs No Obesity: 1.61 ± 0.737 p:0.035) and they were under treatment with prednisone more frequently (Obese: 69% vs. No Obese: 52% p: 0.028). Non-obese patients achieved remission measured by SDAi in a greater proportion (Obese: 1.5% vs Non-Obese: 15% p:0.009). Conclusion: There is a high frequency of obesity and overweight in our population of pa- tients with RA. Obese patients needed a greater number of DMARDs and prednisone, and achieved remission measured by SDAi in a lower percentage. it is essential to rigorously control the weight by encouraging loss of excess weight and educating patients, in order to improve the severity and prognosis of the disease and indirectly, the quality of life of our patients.