Obese Rheumatoid Arthritis Patients Research Articles

Clinical disease activity index versus disease activity score (28 joints) for assessment of disease activity in obese patients of rheumatoid arthritis

Background: Measurement of disease activity by Disease Activity Score 28 joints -Erythrocyte Sedimentation Rate (DAS28-ESR), Disease Activity Score (28 joints)-C-Reactive Protein (DAS28-CRP), and Clinical Disease Activity Index (CDAI) has become an integral part of management of Rheumatoid Arthritis (RA), by ‘Treatment to Target’ approach. With the exception of CDAI, the other two use inflammatory markers ESR and CRP to measure disease activity. Obesity is also known to increase inflammatory markers like CRP. We undertake this study to examine if obesity confounds the disease activity measurement in RA leading to overestimation of disease activity. Methods: A cross-sectional observation study was conducted on one hundred patients of RA (40 obese and 60 non obese) in remission or low disease activity as defined by CDAI. They were divided into obese and non-obese groups based on Indian standards (BMI>25kg/m2). ESR and CRP were measured in both the groups. DAS28-ESR and DAS28-CRP were calculated and compared using relevant statistical tests. Results: DAS28-ESR and DAS-28-CRP scores were significantly higher in the obese subjects, despite both groups having comparable CDAI scores. Similar findings were also observed with inflammatory markers ESR and CRP, both being higher in obese patients. Conclusions: We conclude that indices incorporating inflammatory markers, like DAS28 overestimate disease activity in obese RA patients. Treatment decisions regarding escalation or addition of DMARDs should be taken after considering the same. CDAI appears to be better suited for disease activity measurements in obese RA patients as compared to DAS 28.

Dietary Pattern or Weight Loss: Which One Is More Important to Reduce Disease Activity Score in Patients with Rheumatoid Arthritis? A Randomized Feeding Trial.

Objectives Herein, disease activity score 28 (DAS 28) was compared between patients with rheumatoid arthritis (RA) receiving the Mediterranean dietary pattern (MD) and low-fat diet. Subjects/Methods. Overweight and obese RA patients aged 15–75 y participated in this randomized feeding trial. Participants were randomized to MD (n = 51) and low-fat high-carbohydrate diet (n = 53) for 12 weeks. The control group followed their regular diet (n = 50). Participants completed the form of tender and swollen joint counts before the study enrollment and after 12 weeks to compute DAS 28. Results Weight loss was not statistically significant between the MD and LF-HC groups. DAS 28 significantly decreased in MD compared to the LF-HC group (p=0.02) and controls (p=0.001). Adjusting for the baseline variables, MD reduced DAS 28 by 76% (95% CI = −0.45, −0.2; p=0.03) after 12 weeks of intervention. The baseline serum ESR level showed 99.8% effect on DAS 28 score at the end (95% CI = 0.014, 0.035; p < 0.001). Conclusions The MD showed beneficial effects on DAS 28 compared to the LF-HC diet in patients with RA, regardless of weight loss. It is a better dietary choice for pain reduction in patients with RA. The trial is registered at Iranian Registry of Clinical Trials (IRCT20200929048876N2).

Molecular Changes in the Adipose Tissue Induced by Rheumatoid Arthritis: Effects of Disease-Modifying Anti-Rheumatic Drugs

Disease severity, progression and response to therapy might be worse in obese rheumatoid arthritis (RA) patients, but paradoxically, obesity also might protect from radiographic joint damage. Thus, the intricate relationship between obesity and RA needs urgent clarification. The aim of this study was to assess the influence of obesity on the onset and development of RA and to determine whether arthritis could modify the adipose tissue biology and whether conventional Disease Modifying Anti-Rheumatic Drugs (cDMARDs) can modulate these alterations. Two strategies were followed: (1) clinical profiling of two cohorts of RA: non-obese and obese patients; and (2) mechanistic studies carried out in both a collagen-induced arthritis (CIA) in an obese mouse model and 3T3-L1 adipocytes treated with cDMARDs (leflunomide, methotrexate, and hydroxychloroquine). In our cohort of RA patients with low-moderate disease activity, the presence of obesity was not related to a higher activity of the disease; actually, disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR) was reduced in the obese RA patients. However, the induction of arthritis promoted transcriptomic changes in the adipose tissue under obesity condition in the obese CIA model. Treatment with hydroxychloroquine reduced weight and insulin resistance, accompanied by beneficial metabolic effects in the adipose tissue. These molecular changes in adipose tissue were also observed after methotrexate administration. In sum, arthritis might affect directly the inflammatory burden and metabolic alterations associated with obesity in adipose tissue. Clinicians should be cautious measuring the activity of the disease in obesity and managing the best therapeutic options for the metabolic comorbidities of these patients, where the combination of hydroxychloroquine and methotrexate should be considered to improve adipose tissue dysfunction in obese RA.

Comparison of Psoriatic Arthritis and Rheumatoid Arthritis Patients across Body Mass Index Categories in Switzerland.

Abnormal body mass index (BMI) was associated with worse rheumatic markers in psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Aiming to describe PsA and RA patients stratified by BMI, we performed a descriptive study in PsA and RA patients (two distinct cohorts) in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry. New users of biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) were stratified by BMI at the start of their treatment (underweight, normal weight, overweight, obese). The PsA underweight and normal weight categories were merged. Age at disease onset and further characteristics at the start of the first b/tsDMARD treatment were compared across BMI categories vs. the corresponding normal weight group. The study included 819 PsA (36.5% overweight, 23.8% obese) and 3217 RA patients (4.4% underweight, 31.8% overweight, 17.0% obese). Compared to the corresponding normal weight group, PsA and RA obese patients had significantly (p < 0.05) higher C-reactive protein, worse disease activity, and lower quality of life (QoL). Obese PsA patients had significantly worse skin manifestation and pain, while obese RA patients had significantly higher erythrocyte sedimentation rate and tender joint counts, as well as lower seropositive prevalence. To conclude, obese PsA and RA patients presented worse disease activity and poorer QoL than those with normal weight.

High Body Mass Index is Associated with Shorter Retention of Tumor Necrosis Factor-Alpha Blocker Treatment in Rheumatoid Arthritis.

PurposeTo evaluate the association between body mass index (BMI) and tumor necrosis factor α (TNF-α) blockers retention in patients with rheumatoid arthritis (RA).Patients and MethodsThis prospective cohort study analyzed data about patients with RA who initiated TNF blockers from the Israeli registry of inflammatory diseases from 2011 to 2019. Patients were grouped by BMI: normal (BMI <24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), obese (BMI 30–34.9 kg/m2) and morbid obese (BMI ≥35 kg/m2). Treatment cessation due to inefficacy was defined as an “event” and therapy with a drug above 3 months was defined as a “course.” Kaplan–Meier survival curve was used to describe drug survival. Event-free survival was calculated using Cox regression with a hazard ratio and confidence interval of 95%.ResultsThe final analysis included 521 RA patients (80% females) treated with etanercept, infliximab, adalimumab or golimumab. Eight hundred and eighteen treatment initiations were included in the final analysis, 334 (41%) in the normal weight group, 261 (32%) in the overweight, 144 (17%) in the obese and 79 (10%) in the morbid obesity group. Three hundred and twenty-six (40%) treatment initiations were with etanercept, 215 (26%) with adalimumab 197 (24%) with infliximab, and 80 (10%) with golimumab. BMI was inversely associated with drug survival. Morbid obese patients were more likely to discontinue treatment compared with normal weight patients HR 2.28 (95% CI 1.67–3.10, p<0.01). This association remained significant for each drug type (except for golimumab) in a subgroup analysis. Adalimumab switch rate was higher compared to etanercept with HR =1.51 (95% CI 1.20–1.91, p<0.01), no other significant differences were noted between the other drugs.ConclusionMorbid obese RA patients have lower TNF-α blocker retention compared to normal weight patients.

THU0610-HPR PREDICTION EQUATION FOR MUSCLE MASS OVERESTIMATES MUSCLE MASS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:Rheumatoid Arthritis (RA) is a chronic, progressive, inflammatory autoimmune disease characterized by systemic manifestations. Often is observed in RA patients changes in body composition, such as reduced muscle mass (sarcopenia) with stable or increased fat mass (FM) [1]. Total-body skeletal muscle mass (SMM), specifically appendicular skeletal muscle, is a key diagnostic feature for the assessment of geriatric syndromes associated with skeletal muscle wasting, such as sarcopenia [2]. Estimation of SMM can be accomplished by a variety of methods, but the majority that considered the gold standard for this purpose are high cost. Due high cost, this methods are unfeasible in population studies and increases the difficulty of use in different clinical contexts. Predictive equations have been developed for estimation of whole-body skeletal muscle mass on the basis of anthropometric data, which can be collected in a more affordable manner, in an attempt to make SMM calculation easier and enable its use in epidemiological research and in clinical settings [3]. However, these equations were not developed for RA populations.Objectives:To compare the anthropometric equation that estimate SMM with body composition measurements derived from DXA in RA patients.Methods:Ninety patients diagnosed with RA according to ACR/EULAR criteria were recruited. Body composition was assessed by total body dual-energy x-ray absorptiometry (DXA) for measurement of appendicular lean mass index (ALMI, kg/m2). The prediction equation for muscle mass proposed by Lee et al (variables included: body weight, height, age, sex and race) was used to generate estimates of SMM, stratified by BMI. Frequency analysis, independent student’s t test and intraclass correlation coefficients (ICC) were performed. Statistical significance was considered as p&lt;0.05Results:Of the 90 patients analyzed, most were women (86.7%; 78/91), with mean age of 56.5±7.3 and median disease duration time of 8.5 (3-18) years. The mean of BMI was 27.39±5.14. Thirty (33.3%) RA patients had normal weight, forty patients (44.4%) were overweight and twenty patients (22.2%) were obese. In normal weight patients, just like overweight and obese patients, the estimates of SMM obtained by Lee equation were higher than those obtained by DXA measurements(Obese: Lee 10.66±1.19 vs DXA 7.10±0.73; Overweight: Lee 8.63±0.99 vs DXA 6.57±0.82; Normal weight: Lee 7.14±0.85vs DXA 6.03±0.71; p&lt;0.05). The Lee equation estimates showed ICC of 0.78 (0.66 - 0.85) with DXA measurements. When stratified by BMI, Lee equation showed ICC of 0.87 (0.72 - 0.94) for normal weight, 0.83 (0.68 - 0.91) for overweight and 0.77 (0.42 - 0.90) for obese with DXA.Conclusion:The muscle mass index by Lee equation overestimates the muscle mass in overweight or obese RA patients compared to DXA. Thus, sarcopenic RA patients may be wrongly classified as normal by the equation. This is probably related to the obese cachexia that these patients often present. More studies are necessary to analysis to better prediction equations for muscle mass in RA patients.

Assessment of renal involvement in an Iraqi cohort of rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is an autoimmune chronic systemic inflammatory disease involves synovial joints but may involve extra-articular organ as well. Objectives: to determine the prevalence of indicators of renal involvement in patients with RA with implications of impact of related drugs on the kidney. Materials and Methods: This cross-sectional study was conducted from May 1, 2019, to November 1, 2019, in the Outpatient Rheumatology Clinic of Hawler teaching hospital, Erbil, Iraq. One hundred and seventy-six patients with seropositive RA were enrolled, other 13 were dropped because of missing data. Participant's characteristics and data regarding drug history were collected. Body mass index (BMI), erythrocyte sedimentation rate (ESR), and serum creatinine were measured; renal function was assessed from the estimated glomerular filtration rate (eGFR) using the modification of diet in renal disease formula. Urine examined for proteinuria, microscopic hematuria, and noninfectious leucocyturia. When eGFR 0.5). Conclusions: Renal disorder is common in RA patients. Regular monitoring of renal involvement by using eGFR and urinary dipstick is crucial, especially in the elderly obese RA patients with a long duration of the disease and proteinuria. Early identification of renal disease can facilitate the early intervention and achieve the better management of RA patients.

Emotional eating is more frequent in obese rheumatoid arthritis patients

Obesity is a risk factor for both cardiovascular mortality and poor disease control. Unfavourable eating behaviours may have a role in obesity and increase the risk for obesity. In this study, we evaluated the eating behaviours of the patients with rheumatoid arthritis and compare these with controls. Also, we assessed the eating behaviour differences between obese and non-obese rheumatoid arthritis patients. It was a cross sectional case control study. We enrolled 157 rheumatoid arthritis patients and 60 controls to the study in one year period. We evaluated the eating behaviours of the patients with Three-Factor Eating Questionnaire R-18. Firstly, we compared eating behaviours of the rheumatoid arthritis patients with controls, and then we evaluated the differences in eating features between obese rheumatoid arthritis patients with non-obese rheumatoid arthritis patients. We compared the continuous variables with Mann-Whitney u test. Furthermore, categorical variables were compared with Chi-square test. Sixty-three (40.2%) of the rheumatoid arthritis patients were obese. Eating behaviours of rheumatoid arthritis patients and controls were similar, out of uncontrolled eating score. This score was found higher in control group than rheumatoid arthritis patients (p=0.01). Moreover, emotional eating domain scores were higher in obese RA patients (p=0.04). Even though there were no negative eating features in general rheumatoid arthritis population, obese rheumatoid arthritis patients may have an emotional eating problem. Herein, treatments that address psychosomatic sides of eating may be effective for treatment of obesity in rheumatoid arthritis.

Obesity Impacts Swelling of Ankle and Foot Joints in Early Rheumatoid Arthritis Patients.

The evaluation of disease activity in obese rheumatoid arthritis (RA) patients presents challenges particularly in the clinical assessment of swollen joints. This study examines the effect of obesity on the American College of Rheumatology (ACR) core set measures used in assessing RA disease activity with specific focus on the swollen joint count (SJC). We examined a cross-sectional cohort of 323 early seropositive RA patients (symptom duration ≤15 months). Patients were biologic-naive with equal to or more than 6/44 SJC and equal to or more than 9/44 tender joint count. The ACR core set measures, components of Disease Activity Score (DAS) 44/erythrocyte sedimentation rate (ESR), DAS28/ESR4 item, Clinical Disease Activity Index (CDAI), and body mass index (BMI) were collected. Disease activity measures were compared between BMI categories. Multivariable linear regression models assessed the relationship between high BMI (≥30 kg/m) and lower-extremity (LE) SJC and SJC44 while accounting for other ACR measures. Disease Activity Score 44/ESR4 item, Health Assessment Questionnaire Disability Index, physician global, and SJC44 differed across BMI categories (p < 0.05). Of the SJC44, metacarpophalangeal joints and LE joints (knees, ankles, metatarsophalangeal joints) were associated with increased swelling in all BMI groups (P < 0.05). Obesity was significantly associated with LE SJC after adjusting for ACR core set measures. There is a direct association between increased BMI and increased swelling of LE joints in RA patients. Increases in DAS44-measured disease activity are higher in obese RA patients because of increased LE swollen joints. Disease Activity Score 28 and Clinical Disease Activity Index, which emphasize upper-extremity joint assessment, are not significantly influenced by obesity.

Impact of obesity on rheumatoid arthritis: Relation with disease activity, joint damage, functional impairment and response to therapy

Background and Aim of Work: The impact of Body Mass Index (BMI) on outcomes of Rheumatoid Arthritis (RA) is uncertain. This study aimed to evaluate the influence of obesity on Egyptian patients with RA. Methods: Medical records of 146 RA patients were reviewed. Patients were categorized into normalweight, overweight and obese groups based on BMI. The clinical and laboratory indices of RA activity, the Health Assessment Questionnaire (HAQ) and the radiographic damage score were compared among the groups at baseline, 8, 16 and 24 months. Results: DAS28 and HAQ score were matched at baseline but improved in the 3 groups thereafter, however, differences among the groups become significant only at 24-month. At the 24-month, DAS28 was significantly better in normal-weight (2.1 ± 1.0) and in overweight groups (2.2 ± 0.8) compared to obese group (2.7 ± 1.0) (normal-weight vs obese p=0.003 and overweight vs obese p= 0.006). At the 24-month, HAQ score was significantly better in normal-weight (0.78 ± 0.6) and in overweight groups (0.82 ± 0.5) compared to obese group (1.09 ± 0.7) (normal-weight vs obese p= 0.16 and overweight vs obese p= 0.041). The radiological Sharp-van der Heijde Score along the study period was lower in obese than in overweight or normal-weight patients, albeit the differences in the radiological score were insignificant among the groups. Conclusion: Obese patients were shown to have a poorer response rate to treatment in all outcome measures in comparison to the overweight and the normal-weight RA patients. Future research work is required to investigate whether weight reduction can decrease non-remission rate among the obese RA patients.

Joint-specific assessment of swelling and power Doppler in obese rheumatoid arthritis patients

BackgroundClinical swollen joint examination of the obese rheumatoid arthritis (RA) patient can be difficult. Musculoskeletal Ultrasound (MSUS) has higher sensitivity than physical examination for swollen joints (SJ). The purpose of this study was to determine the joint-specific association between power Doppler (PDUS) and clinical SJ in RA across body mass index (BMI) categories.MethodsCross-sectional clinical and laboratory data were collected on 43 RA patients. PDUS was performed on 9 joints (wrist, metacarpalphalangeal 2–5, proximal interphalgeal 2/3 and metatarsalphalangeal 2/5). DAS28 and clinical disease activity index (CDAI) were calculated. Patients were categorized by BMI: <25, 25–30, and >30. Demographic and clinical characteristics were compared across BMI groups with Kruskal-Wallis test and chi-square tests. Joint-level associations between PDUS and clinically SJ were evaluated with mixed effects logistic regression models.ResultsWhile demographics and clinically-determined disease activity were similar among BMI groups, PDUS scores significantly differed (p = 0.02). Using PDUS activity as the reference standard for synovitis and clinically SJ as the test, the positive predictive value of SJ was significantly lower in higher BMI groups (0.71 in BMI < 25, 0.58 in BMI 25–30 and 0.44 in BMI < 30) (p = 0.02). The logistic model demonstrated that increased BMI category resulted in decreased likelihood of PDUS positivity (OR 0.52, p = 0.03).ConclusionsThis study suggests that in an obese RA patient, a clinically assessed SJ is less likely to represent true synovitis (as measured by PDUS). Disease activity in obese RA patients may be overestimated by CDAI/DAS28 calculations and clinicians when considering change in therapy.

Obesity is the main determinant of insulin resistance more than the circulating pro-inflammatory cytokines levels in rheumatoid arthritis patients

BackgroundSystemic blockade of TNF-α in Rheumatoid arthritis with insulin resistance seems to produce more improvement in insulin sensitivity in normal weight patients with Rheumatoid arthritis than in obese patients with Rheumatoid arthritis, suggesting that systemic-inflammation and obesity are independent risk factors for insulin resistance in Rheumatoid arthritis patients. ObjectivesTo evaluate the insulin resistance in: normal weight patients with Rheumatoid arthritis, overweight patients with Rheumatoid arthritis, obese Rheumatoid arthritis patients, and matched control subjects with normal weight and obesity; and its association with major cytokines involved in the pathogenesis of the disease. MethodsAssessments included: body mass index, insulin resistance by Homeostasis Model Assessment, ELISA method, and enzymatic colorimetric assay. ResultsOutstanding results from these studies include: (1) In Rheumatoid arthritis patients, insulin resistance was well correlated with body mass index, but not with levels of serum cytokines. In fact, levels of cytokines were similar in all Rheumatoid arthritis patients, regardless of being obese, overweight or normal weight (2) Insulin resistance was significantly higher in Rheumatoid arthritis with normal weight than in normal weight (3) No significant difference was observed between insulin resistances of Rheumatoid arthritis with obesity and obesity (4) As expected, levels of circulating cytokines were significantly higher in Rheumatoid arthritis patients than in obesity. ConclusionsObesity appears to be a dominant condition above inflammation to produce IR in RA patients. The dissociation of the inflammation and obesity components to produce IR suggests the need of an independent therapeutic strategy in obese patients with RA.

A obesidade é um determinante da resistência à insulina mais importante do que os níveis circulantes de citocinas pró‐inflamatórias em pacientes com artrite reumatoide

BackgroundSystemic blockade of TNF‐α in Rheumatoid arthritis (RA) with insulin resistance (IR) seems to produce more improvement in insulin sensitivity in normal weight patients with RA than in obese patients with RA, suggesting that systemic‐inflammation and obesity are independent risk factors for IR in RA patients. ObjectivesTo evaluate the insulin resistance in: normal weight patients with RA (RA NW), overweight patients with RA (RA OW), obese RA patients (RA OB), and matched control subjects with normal weight (NW) and obesity (OB); and its association with major cytokines involved in the pathogenesis of the disease. MethodsAssessments included: body mass index (BMI), insulin resistance by HOMA‐IR, ELISA method, and enzymatic colorimetric assay. ResultsOutstanding results from these studies include: (1) In RA patients, IR was well correlated with Body Mass Index (the higher the BMI, the higher IR), but not with levels of serum cytokines. In fact, levels of cytokines were similar in all RA patients, regardless of being obese, overweight or normal weight (2) IR was significantly higher in RA NW than in NW (3) No significant difference was observed between IRs of RA OB and OB (4) As expected, levels of circulating cytokines were significantly higher in RA patients than in OB. ConclusionsObesity appears to be a dominant condition above inflammation to produce IR in RA patients. The dissociation of the inflammation and obesity components to produce IR suggests the need of an independent therapeutic strategy in obese patients with RA.

Body mass does not impact the clinical response to intravenous abatacept in patients with rheumatoid arthritis. Analysis from the "pan-European registry collaboration for abatacept (PANABA).

Some evidences suggest that obesity impairs the effectiveness of TNF inhibitors. We examined the impact of body mass index (BMI) on the clinical effectiveness of abatacept in rheumatoid arthritis (RA) patients. This is a pooled analysis of 10 prospective cohorts of RA patients. All patients with available BMI were included in this study. The primary endpoint was drug retention of abatacept in the different BMI categories. Multivariable Cox regression was used to estimate hazard ratios (HRs) for drug discontinuation. A secondary endpoint was EULAR/LUNDEX response rates at 6/12months. Of the 2015 RA patients initiating therapy with IV abatacept, 380 (18.9%) were classified as obese. Obese patients had more functional disability, and were less often RF positive. The median abatacept retention time was 1.91years for obese RA patients compared to 2.12years for non-obese patients (p=0.15). The risk of abatacept discontinuation was not significantly different for overweight (HR 1.03 (95% CI 0.89-1.19)), or for obese (HR 1.08 (95% CI 0.89-1.30)) compared to normal-weight patients. Rheumatoid factor positivity reduced the risk of abatacept discontinuation (HR 0.83 (95% CI 0.72-0.95)), while previous biologic therapy was positively associated with drug interruption (HRs increasing from 1.68 to 2.16 with the line of treatments). Obese and non-obese patients attained similar rates of EULAR/LUNDEX clinical response at 6/12months. Drug retention and clinical response rates to abatacept do not seem to be decreased by obesity in RA patients.

Serum pentraxin 3 levels are negatively associated with carotid intima media thickness in non-obese rheumatoid arthritis patients

BackgroundPentraxin-3 (PTX3) is a long pentraxin that is supposed to participate in the inflammatory process and in atherosclerosis. AimTo study PTX3 serum levels in rheumatoid arthritis (RA) patients to know if its serum levels may reflect disease activity and/or subclinical atherosclerosis. MethodsPTX3 and carotid intima media thickness (IMT) were studied in 85 RA patients (83.5% females, median age of 59years old, median disease duration of 13years) along with its demographic, clinical, serological and lipid profile. For comparison PTX3 was measured in 85 healthy volunteers. ResultsPTX3 levels in RA patients were similar to controls (p=0.21) and did not correlate with inflammatory activity measured by ESR (p=0.39) CRP (p=0.18) and DAS28 (p=0.67). Serum PTX3 levels were higher in nonobese RA patients than in obese (BMI vs PTX3 with rho=−0.27; 95%IC=−0.46 to −0.06; p=0.009). In non-obese patients, PTX3 correlated negatively with carotid IMT (rho=−0.40; 95%IC=−0.66 to −0.06; p=0.01) but not in the obese ones (p=0.26). In the obese RA patients there was a negative correlation between PTX3 levels and LDL/HDL ratio (Rho=−0.29; 95%IC=−0.53–0.01; p=0.03). ConclusionsPTX3 levels do not reflect inflammatory process in RA. However, it exerts a protective role in the process of atherogenesis in non-obese RA patients.

Body mass index and response to tocilizumab in rheumatoid arthritis: a real life study

Several studies have suggested that obesity could have a negative effect on response to anti-tumor necrosis factor α (anti-TNFα) in rheumatoid arthritis (RA). Little is known about the impact of body mass index (BMI) on other biologic agents. We aimed to evaluate the effect of BMI on response to tocilizumab (TCZ) in RA. RA patients treated with TCZ were included in this multicenter retrospective study. BMI was calculated at the initiation of treatment. After 6months of treatment, change from baseline in DAS28, pain on a visual analog scale, erythrocyte sedimentation rate and C-reactive protein level, and tender and swollen joints were analyzed. The primary endpoint was decrease in DAS28 ≥ 1.2. Secondary outcomes were good response and remission by EULAR criteria. At baseline, among 115 RA patients included, the median (interquartile range) BMI was 25.4 (22.0-28.8) kg/m(2). The number of patients with normal weight, overweight, and obesity was 53 (46%), 37 (32%), and 25 (22%), respectively. Baseline characteristics did not differ between the three subgroups of BMI. The median BMI did not differ between responders and non-responders for DAS28 decrease ≥1.2 (25.7 [22.1-29.9] vs 24.9 [22.0-27.1], P = 0.38), EULAR good response (25.9 [22.8-30.0] vs 25.4 [22.0-28.4], P = 0.61), and remission (25.1 [22.5-28.6] vs 25.4 [22.0-28.9], P = 0.76). BMI did not affect the response to TCZ in RA. If confirmed, these results could be helpful for the selection of a biologic agent in obese RA patients.

Impact of obesity on functional and laboratory parameters in patients with rheumatoid arthritis

Overweight patients with rheumatoid arthritis (RA) have more disease activity, lower rates of remission, and twice as likely to require a tumor necrosis factor inhibitor. Provided that the prevalence of obesity is increasing, this may significantly affect RA incidence. An association between obesity and RA is logic, as biologic mechanisms of inflammation are present in fatty tissue, and it may be a trigger to chronic systemic inflammation. Human obesity is characterized by increased plasma leptin levels, which if elevated in morbidly obese patients may enhance constitutive immunological stimuli and increased levels of inflammatory marker. The aim of this study was to assess the impact of obesity and serum leptin level on disease activity and functional outcome in RA patients. This study was carried out at Minia University Hospital, Egypt. Patients were recruited from Rheumatology Outpatient Clinic from October 2012 to June 2013. It included 36 RA patients, fulfilling the 2010 ACR/EULAR classification criteria. They were divided into two groups: obese patients with a BMI of 25 or greater and nonobese patients (BMI ≤ 25). A total of 12 healthy individuals were included as controls. All patients were subjected to history taking and clinical examination; patient’s functional status and disease activity were assessed using the Health Assessment Questionnaire (HAQ) disability index and DAS-28, respectively. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and rheumatoid factor (RF) were determined. Serum level of leptin was measured using enzyme-linked immunosorbent assay. Data were analyzed using SPSS for Windows, version 16.0. RA obese patients showed a higher duration of morning stiffness (P = 0.02), HAQ index (P = 0.001), DAS-28 (P = 0.0001), visual analogue scale (VAS) of pain (P = 0.0001), and articular index (P = 0.001) compared with nonobese ones. They showed higher ESR (P = 0.003), serum leptin (P = 0.008), CRP (P = 0.0001), and RF (P = 0.002). There was a positive correlation between BMI and each of ESR (P = 0.003), CRP (P = 0.0001), and RF (P = 0.01). There was a positive correlation between waist circumference and each of ESR (P = 0.03), serum leptin (P = 0.03), CRP (P = 0.0001), and RF (P = 0.04). There was a positive correlation between BMI and HAQ index (P = 0.0001), DAS-28 (P = 0.001), articular index (P = 0.003), and VAS of pain (P = 0.0001). There was a positive correlation between waist circumference and HAQ index (P = 0.001), DAS-28 (P = 0.03), and VAS of pain (P = 0.0001). Moreover, there was a positive correlation between VAS of pain and serum leptin (P = 0.04). Serum leptin was correlated with CRP (P= 0.01). Linear regression analysis showed that the VAS was the first and most significant risk factor (β = 0.73; P = 0.01) and that HAQ was the second (β = –0.53; P = 0.04) to affect serum leptin levels. Obese RA patients had higher disease activity parameters, clinical scores and laboratory indices, and worse functional outcomes compared with nonobese patients. Higher serum leptin levels were associated with higher disease activity scores.

High rates of obesity and greater associated disability among people with rheumatoid arthritis in Canada.

Obesity in rheumatoid arthritis has been associated with increased risk of comorbidities, larger medical costs, decreased quality of life, higher disease activity, and reduced therapeutic responses. We assessed the burden of obesity among rheumatoid arthritis patients and its impact on patient-reported outcomes. Patients receiving care at two Canadian University Centers were included. Height and weight were measured and selected sociodemographic and rheumatoid arthritis (RA) characteristics as well as patient-reported outcomes were obtained. Patients were classified according to WHO criteria and proposed RA cut points, and results were compared with national data. Using WHO criteria, 68 (34 %) RA patients were classified as obese (vs. ~25 % of Canadians). Using RA cut points, 112 (55 %) RA patients were classified as obese. With both classification methods, obese individuals had significantly higher mean HAQ scores and a higher odds of significant disability (HAQ ≥ 1: WHO OR 2.3; 95 % CI 1.2, 4.2 and RA-specific OR 1.8; 95 % CI 1.0, 3.2). Independent of the classification method use, RA patients have significantly higher rates of obesity than national prevalence estimates. Obese RA patients had about twice the odds of reporting moderate to severe disability.

Serum leptin and serum leptin/serum leptin receptor ratio imbalance in obese rheumatoid arthritis patients positive for anti-cyclic citrullinated peptide antibodies

IntroductionLeptin has a prominent role in the development and maintenance of acute and chronic inflammatory states such as rheumatoid arthritis (RA) and obesity. Nevertheless, the association of serum leptin (sLep) and soluble leptin receptor (sLepR) in RA pathogenesis has not been clarified. The purpose of this study was to evaluate the association of sLep, sLepR and leptin production indexes such as sLep/fat mass ratio with clinical activity and biomarkers and anti-cyclic citrullinated peptide (anti-CCP) antibodies in RA compared with body mass index (BMI) matched control subjects.MethodsWe included 64 RA patients and 66 controls matched for age, gender and BMI. Subjects were evaluated for BMI, fat mass distribution, sLep, sLepR, sLep/fat mass ratio and sLepR/fat mass ratio. Patients were evaluated for clinical activity and anti-CCP antibodies.ResultsWe found two or three fold increased sLep levels, sLep/sLepR ratio and sLep/fat mass ratio in obese anti-CCP positive RA patients vs. controls. Partial correlations showed that anti-CCP antibodies were correlated with sLep/fat mass ratio (partial r = 0.347, P = 0.033) after adjustment for age, subcutaneous adipose tissue and fat mass.ConclusionsIn preobese and obese RA patients there is and increased production of sLep according to anti-CCP positivity. This phenomenon suggests there is an additive effect of chronic inflammation resulting from RA and obesity in which leptin favors the humoral response against citrullinated proteins. In summary, the data observed in our study suggests sLep could be a surrogate marker of chronicity and humoral immunity in RA in the presence of obesity.

Obesity reduces the drug survival of second line biological drugs following a first TNF-α inhibitor in rheumatoid arthritis patients

ObjectivesThe aim of this study was to assess whether body mass index (BMI) affects clinical outcomes in rheumatoid arthritis (RA) patients starting a second line biological drug after failure of a first TNF-α blocker. MethodsFrom a longitudinal cohort, we analyzed 292 RA patients (66 obese, 109 overweight, and 117 normal-weight) treated with a first ever anti-TNF-α drug. Patients discontinuing the therapy were followed-up if began a second biological drug. Drug survival, by Kaplan-Meier life analysis, and 12 months disease remission based on the 28-joint Disease Activity Score (DAS28) were assessed for either course of biologics. The baseline predictors of clinical outcomes were assessed by Cox regression analysis. ResultsSurvival of the first anti-TNF-α drug was lower in obese (39.4%) than in normal-weight (49.1%) patients, but the difference was not statistically significant. Obese patients had the highest hazard to discontinue the first anti-TNF-α drug (HR 1.64, 1.02–2.62 95% IC, P=0.04), and the lowest percentage of DAS28-based disease remission at 12 months (P=0.04). In 97 (37 normal-weight, 36 overweight, 24 obese) patients who started a second non-anti-TNF-α biological drug, persistence on therapy was significantly lower in obese (43.5%) than in normal-weight (80%, P=0.04) group, and again obesity significantly predicted drug discontinuation (HR 2.9, 1.08–8.45 95% IC, P=0.04). Significantly, less obese patients attained a disease remission (12%, P=0.004) at 12 months. ConclusionOur study provides evidence that obese RA patients poorly respond to second line non-anti-TNF-α drugs after failure of a first TNF-α inhibitor.