Obesity Increases Disease Activity of Norwegian Patients with Axial Spondyloarthritis: Results from the European Map of Axial Spondyloarthritis Survey

Christian Bindesbøll,Hanne Dagfinrud,Gunnstein Bakland,Marco Garrido-Cumbrera

doi:10.1007/s11926-020-00917-4

Abstract

ObjectiveTo investigate the prevalence of overweight and obesity, as well as the association between body mass index (BMI) and disease activity in patients with axial spondyloarthritis (axSpA).MethodsNorwegian axSpA patients from the European Map of Axial Spondyloarthritis (EMAS) survey were included in this analysis. Sociodemographic, anthropomorphic, and disease-related variables (HLA-B27, comorbidities, BASDAI, and self-reported spinal stiffness) were reported. Patients were categorized into under/normal weight (BMI < 25 kg/m2), overweight (BMI ≥ 25 to < 30 kg/m2), and obese (≥ 30 kg/m2).ResultsOf the 509 participants in the EMAS survey, 35% were categorized as under/normal weight, 39% overweight, and 26% obese. Compared to under/normal-weight patients, overweight patients had significantly higher degree of spinal stiffness (mean (SD) 7.91 ± 2.02 vs 7.48 (2.15) and number of comorbidities (2.45 ± 2.11, vs 1.94), both p < 0.001. Obese patients had significantly higher disease activity (BASDAI mean (SD) 5.87 ± 1.78 vs 4.99 ± 2.08, p < 0.001), degree of spinal stiffness (8.18 ± 2.03 vs 7.48 ± 2.15, p = 0.006), and number of comorbidities (3.43 ± 2.43 vs 1.94. ± .38, p < 0.001) than under/normal weight patients. After adjusting for gender and age, obesity proved to be independently associated with disease activity.ConclusionObesity was associated with higher reported BASDAI score, and being overweight or obese was associated with a higher degree of spinal stiffness and number of comorbidities compared to under/normal weight respondents. The results highlight the serious impact of obesity on health status, and obesity should therefore be considered as a modifiable risk factor for disease activity within the disease management of axSpA.

Highlights

Axial spondyloarthritis is a chronic inflammatory rheumatic disease that primarily affects the axial skeleton [1]
The axSpA diagnosis comprises radiographic axSpA, which corresponds to ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis
Current treatment recommendations for people with inflammatory arthritis underline the importance of appropriately dosed physical activity to improve cardiorespiratory fitness and muscle strength [2, 3], but still, people with axSpA are shown to be less physically active and have lower physical fitness compared to the general population [4, 5]

Summary

Introduction

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that primarily affects the axial skeleton [1]. Knowledge about how obesity influences disease activity in axSpA patients is, limited. A small study reported more functional limitations and higher subjective disease activity and reduced the benefit of exercise in obese compared to normal weight AS patients [8]. Overweight axSpA patients are reported to show significantly lower response to tumor necrosis factor (TNF) inhibitors than normal-weight patients [10,11,12]. This knowledge adds to the existing large body of evidence of the negative health effects of excessed weight [13]

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Results

Conclusion