Studies examine the effects of weight on patients with rheumatoid arthritis

November 30, 2017, Wiley

New research provides insights on the potential effects of weight on the health of individuals with rheumatoid arthritis (RA). A study published in Arthritis Care & Research examines how overweight and obesity may affect the likelihood of achieving remission in early RA. A separate study in Arthritis & Rheumatology focuses on weight change in early RA and patients' subsequent risk of early death.

Research has suggested that may influence the effectiveness of RA therapies. In an Arthritis Care & Research study, Susan Goodman, MD, of the Hospital for Special Surgery and Weill Cornell Medical School, and her colleagues investigated the potential impact of weight on the likelihood that patients would achieve remission in the early years after an RA diagnosis. The team examined data from the Canadian Early Arthritis Cohort, a multicenter observational trial of patients with early RA who were treated by rheumatologists using guideline-based care.

"Our study looks at people with recently diagnosed, early RA, who should have the best outcomes and best responses to treatment, and sees how many are either or obese, and then determines if those who are overweight or obese have worse outcomes than those with healthy weight," said Dr. Goodman.

Of 982 patients, 32 percent had a healthy BMI, 35 percent were overweight, and 33 percent were obese. Within three years, 36 percent of patients experienced sustained remission. Compared with patients with a healthy BMI, those who were overweight were 25 percent less likely to experience sustained remission, and those who were obese were 47 percent less likely to do so, despite receiving similar treatments.

The research represents the largest study demonstrating the negative impact of excess weight on the RA disease activity and supports a call to action to better identify and address this risk in patients.

"These findings have important implications for clinical care since rates of overweight and obesity continue to rise," said Dr. Goodman. "Our findings highlight the high proportion of newly diagnosed RA patients who are overweight or obese and who may have disease that is harder to treat. For people with RA who haven't had an adequate response to treatment, this may be another factor to consider."

In other studies, obesity has been associated with a decreased risk of early death; however, follow-up studies suggest that this "obesity paradox" may be explained by unintentional weight loss in the few years preceding death, rather than a truly protective effect of obesity. According to this explanation, patients with longstanding RA who reached normal or underweight BMI have higher observed mortality and are relatively less healthy than RA patients who maintained obesity or overweight.

To investigate the issue, Jeffrey Sparks, MD, MMSc, of Brigham and Women's Hospital and Harvard Medical School, and his colleagues evaluated the effect of weight change in the early stages of RA on subsequent mortality risk. Their Arthritis & Rheumatology study included 902 women diagnosed with RA in the Nurses' Health Study and 7884 matched women without RA.

Women with RA had higher mortality rates than women without RA. Among women with RA, 41 percent died during an average follow-up of 17.0 years after the early RA period; among women without RA, 29.2 percent died during an average follow-up of 18.4 years. In both groups, women who had severe weight loss (>30 pounds) had the highest mortality rates after the early RA period. Weight gain in the early RA period was not associated with mortality for either group.

"Our study is the first to focus on weight change around RA diagnosis and risk of death, rather than weight change in patients who had RA for many years, as in previous studies," said Dr. Sparks. "Our findings provide evidence that the results of earlier studies—that who had normal weights were at higher risk of death—may have been related to unintended as opposed to a protective effect of being overweight or obese. Our results demonstrate that these prior findings were less likely to be directly related to RA and were likely a phenomenon of frailty and aging of the general population."

Explore further: Obesity associated with higher degree of synovitis in rheumatoid arthritis patients

More information: Elizabeth Schulman et al, Overweight and Obesity Reduce the Likelihood of Achieving Sustained Remission in Early Rheumatoid Arthritis: Results from the Canadian Early Arthritis Cohort Study, Arthritis Care & Research (2017). DOI: 10.1002/acr.23457

Jeffrey A. Sparks et al. Weight change in the early rheumatoid arthritis period and risk for subsequent mortality among women with RA and matched comparators, Arthritis & Rheumatology (2017). DOI: 10.1002/art.40346

Related Stories

Obesity associated with higher degree of synovitis in rheumatoid arthritis patients

November 5, 2017
Excess weight is linked to a higher degree of synovitis in people with rheumatoid arthritis and can affect their treatment response, according to new research findings presented this week at the 2017 ACR/ARHP Annual Meeting ...

Central obesity ups mortality across BMI range

April 25, 2017
(HealthDay)—Central obesity is associated with increased risk of mortality even in normal-weight individuals, according to a study published online April 24 in the Annals of Internal Medicine.

RA patients who smoke or are overweight see less symptom improvement with treatment

November 15, 2016
A study finds that smoking or being overweight makes it more difficult for patients with rheumatoid arthritis to achieve optimal control of inflammation and symptoms, despite standard of care treatment. American and Canadian ...

Obesity and smoking reduces likelihood of treatment success in early rheumatoid arthritis

June 9, 2016
The results of a study presented today at the European League Against Rheumatism Annual Congress (EULAR 2016) showed that the likelihood of achieving sustained remission in early rheumatoid arthritis (RA) is significantly ...

Keeping young women's weight gain to less than 800g/year helps prevent progression from healthy weight to overweight

May 19, 2017
New research presented at this year's European Congress on Obesity (ECO) in Porto, Portugal (17-20 May) shows that rates of weight gain are established by the time women are 18-23 years old. Measuring rates of weight gain ...

Fewer overweight adults report trying to lose weight

March 7, 2017
Although weight gain has continued among U.S. adults, fewer report trying to lose weight, according to a study appearing in the March 7 issue of JAMA.

Recommended for you

How environmental pollutants and genetics work together in rheumatoid arthritis

April 19, 2018
It has been known for more than three decades that individuals with a particular version of a gene—human leukocyte antigen (HLA)—have an increased risk for rheumatoid arthritis.

The bugs in your gut could make you weak in the knees

April 19, 2018
Bacteria in the gut, known as the gut microbiome, could be the culprit behind arthritis and joint pain that plagues people who are obese, according to a new study published today in JCI Insight.

Researchers identify peptide produced during cartilage deterioration as a potential source of osteoarthritis pain

April 11, 2018
Osteoarthritis is one of the most common causes of chronic pain in the world. More than 30 million people in the United States alone suffer from osteoarthritis, or OA, which can affect any moveable joint of the body, including ...

Flare-responsive hydrogel developed to treat arthritis

April 3, 2018
Arthritis flares - the unpredictable and often sudden worsening of arthritis symptoms—can be debilitating. These episodes can make the management of inflammatory arthritis, which includes rheumatoid arthritis and psoriatic ...

Drug compound shows promise against rheumatoid arthritis

March 28, 2018
Scientists have designed a new drug compound that dials down inflammation, suggesting possible future uses against autoimmune disorders such as rheumatoid arthritis.

Chromosomal loop signatures could identify poor drug response in arthritis

March 28, 2018
Chromosomal loop signatures found in blood samples obtained in early rheumatoid arthritis could identify patients that will not respond adequately to 'anchor' treatment drug methotrexate.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.