Overweight and obese patients less likely to achieve remission in early RA
A new study presented today at EULAR 2013, the Annual Congress of the European League Against Rheumatism, shows that overweight and obese patients are less likely to achieve successful remission in early rheumatoid arthritis (ERA) compared to those of normal weight.
Obese and overweight ERA subjects required 2.4 times more anti-TNF therapy throughout the study than normal weight participants without achieving similar remission outcomes.
RA is a chronic, inflammatory autoimmune disease affecting approximately 1 in 100 people worldwide. RA can cause pain, stiffness, progressive joint destruction and deformity, and reduce physical function, workability, quality of life and life expectancy. At least 50% of RA patients in developed countries are unable to hold down a full-time job within 10 years of onset.2
Obesity continues to remain one of the greatest public health challenges of the 21st century; numbers of those affected rise each year, with the disease now causing 10% of deaths in Europe.3
"Obesity and rheumatoid arthritis are both on the rise, with devastating effects on individuals and society as a whole. These data reinforce the link between obesity and inflammation, and establish that BMI is one of the few modifiable variables influencing the major outcomes in RA," said Elisa Gremese, Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, Rome. "There is an urgent need to address the issues of overweight and obesity to improve patients' chance of successful remission."
346 ERA patients with symptom duration <12 months were categorized into one of three BMI classes (normal weight, overweight and obese) and treated according to a treat-to-target strategy aimed at remission. The strategy included strict follow-up visits, treatment with methotrexate up to 25mg/week+steroids, and combination with a TNF blocker if at least a good response according to EULAR criteria* was not obtained.
Data demonstrate that overweight and obese patients reached a lower rate of remission, both with DAS and CDAI‡ criteria, at 6 and 12 month follow-up visits. A higher percentage of obese and overweight ERA patients were under anti-TNF treatment after 12 months of follow-up compared to normal weight.
‡ DAS, Disease Activity Score; clinical index of RA disease activity that combines information from swollen joints, tender joints, the acute phase response and general health. CDAI is a composite index (without acute-phase reactant) for assessing disease activity and is based on the summation of the count of swollen/tender joint count of 28 joints along with patient and physician global assessment on VAS scale for estimating disease activity
1.Gremese AL et al., The body mass index: a determinant of remission in early rheumatoid arthritis [abstract]. EULAR Annual European Congress of Rheumatology; 12-15 June 2013; Madrid, Spain. Abstract nr. OP0178.
2.Chronic diseases and Health Promotion: Chronic Rheumatic Conditions, World Health Organisation. Available from: www.who.int/chp/topics/rheumatic/en/. Last accessed: May 2013
3.Non communicable Diseases: Obesity, World Health Organization. Available from: www.euro.who.int/en/what-we-do … ble-diseases/obesity Last accessed: May 2013
4.Fransen, J & van Riel P, The Disease Activity Score and the EULAR response criteria, Clinical and Experimental Rheumatology, Nov;35(4):745-57