Abstract
ObjectivesTo investigate whether normal variation of adult height is associated with clinical characteristics in rheumatoid arthritis (RA), including disease activity (DAS28), impairment of joint function (mechanical joint score, MJS) and overall disability (health assessment questionnaire, HAQ).MethodsA cohort (134 males, 287 females) of consecutively recruited RA patients of Northern European origin was studied. Height, weight and demographic information were obtained. A core set of disease measurements, including DAS28, MJS and HAQ, were recorded at baseline, 12 and 24 months. Other clinical variables (e.g. disease duration, IgM rheumatoid factor, antibodies to cyclic citrullinated peptide, C-reactive protein, erythrocyte sedimentation rate) were recorded at baseline. Socioeconomic status, smoking status, comorbid condition, other autoimmune conditions and drug therapy were also recorded. Associations were analyzed using univariate statistics and multivariate linear regression models. Mediation tests were also carried out for evaluating the relationship between gender, height and disease measures.ResultsIn males, height was inversely associated with DAS28, MJS and HAQ (at baseline and over 24 months) independent of other factors (e.g. weight, body mass index, age, disease duration, osteoporosis, autoantibodies, erosive disease, joint replacement, steroid use, smoking status, socioeconomic status and comorbid disease). In females, a similar trend was seen but the relationships were non significant. In the whole population, the association of female gender with more active disease and poor function disappeared after adjustment for height. Mediation analysis indicated that height served as a full mediator in the relationship of gender with disease activity and overall disability. Confirmation of these findings was demonstrated in a second RA population (n = 288).ConclusionAdult height is inversely associated with disease activity, impairment of joint function and overall disability in RA, particularly in males. The association of female sex with more severe disease activity and disability appears to be mediated by smaller stature.
Highlights
Body height is among the most visible of human characteristics, and is highly heritable (h2 = 0.8) [1]
Previous studies have found no relationship between height and the risk of developing rheumatoid arthritis (RA) [10,11], but as far as we are aware there have been no studies on whether there is a relationship between height and disease activity or severity in rheumatoid arthritis (RA)
In the present study we investigated whether there was a relationship between height and a number of major disease characteristics in RA, including disease activity, impairment of mechanical joint function and global degree of disability
Summary
Body height is among the most visible of human characteristics, and is highly heritable (h2 = 0.8) [1]. It has been associated with numerous genomic loci (n.100), with each contributing a small amount of effect [2]. It is a complex trait influenced by a variety of environmental factors, including diet and the prenatal environment [3]. It has been suggested that the association of short stature with CVD and other diseases may be related to an increased inflammatory burden in such individuals due to early-life infections which have impact on eventual adult height [12]. The well described association of female sex with more severe disease activity and poor functional outcome appears to be mediated by smaller stature
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