Generic placeholder image

Current Rheumatology Reviews


ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

Body Mass Index Impact on Disease Activity, Clinical and Sonographic Remission Rates in Patients with Rheumatoid Arthritis

Author(s): Tanya Sapundzhieva*, Rositsa Karalilova and Anastas Batalov

Volume 15, Issue 3, 2019

Page: [215 - 223] Pages: 9

DOI: 10.2174/1573397115666181130143239

Price: $65


Aim: To investigate the impact of body mass index (BMI) on clinical disease activity indices and clinical and sonographic remission rates in patients with rheumatoid arthritis (RA).

Patients and Methods: Sixty-three patients with RA were categorized according to BMI score into three groups: normal (BMI<25), overweight (BMI 25-30) and obese (BMI≥30). Thirty-three of them were treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), and 30 with biologic DMARDs (bDMARDs). Patients underwent clinical and laboratory assessment and musculoskeletal ultrasound examination (MSUS) at baseline and at 6 months after initiation of therapy. We evaluated the rate of clinical and sonographic remission (defined as Power Doppler score (PD) = 0) and its correlation with BMI score.

Results: In the csDMARDs group, 60% of the normal weight patients reached DAS28 remission; 33.3% of the overweight; and 0% of the obese patients. In the bDMARDs group, the percentage of remission was as follows: 60% in the normal weight subgroup, 33.3% in the overweight; and 15.8% in the obese. Within the csDMARDs treatment group, two significant correlations were found: BMI score–DAS 28 at 6th month, rs = .372, p = .033; BMI score–DAS 28 categories, rs = .447, p = .014. Within the bDMARDs group, three significant correlations were identified: BMI score–PDUS at sixth month, rs = .506, p =.004; BMI score–DAS 28, rs = .511, p = .004; BMI score–DAS 28 categories, rs = .592, p = .001. Sonographic remission rates at 6 months were significantly higher in the normal BMI category in both treatment groups.

Conclusion: BMI influences the treatment response, clinical disease activity indices and the rates of clinical and sonographic remission in patients with RA. Obesity and overweight are associated with lower remission rates regardless of the type of treatment.

Keywords: Ultrasound, remission, body mass index, rheumatoid arthritis, patients, disease activity.

Graphical Abstract
Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol 2005; 115(5): 911-9.
[] [PMID: 15867843]
Trayhurn P, Wood IS. Signalling role of adipose tissue: adipokines and inflammation in obesity. Biochem Soc Trans 2005; 33(Pt 5): 1078-81.
[] [PMID: 16246049]
Visser AW, Ioan-Facsinay A, de Mutsert R, et al. Adiposity and hand osteoarthritis: the netherlands epidemiology of obesity study. Arthritis Res Ther 2014; 16(1): R19.
[] [PMID: 24447395]
Ajeganova S, Andersson M, HafstrÖm I. BARFOT study group. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: A Long-term follow-up from disease onset. Arthritis Care Res 65 78-87.2013;
Schoffman D, Wilcox S, Baruth M. Association of body mass index with physical function and health-related quality of life in adults with arthritis. Arthritis : 10642013
Wolfe F, Michaud K. Effect of body mass index on mortality and clinical status in rheumatoid arthritis. Arthritis Care Res 2012; 64: 1471-9.
Lu B, Hiraki LT, Sparks JA, et al. Being overweight or obese and risk of developing rheumatoid arthritis among women: a prospective cohort study. Ann Rheum Dis 2014; 73(11): 1914-22.
[] [PMID: 25057178]
Feng J, Chen Q, Yu F, et al. Body mass index and risk of rheumatoid arthritis: A meta-analysis of observational studies. Medicine (Baltimore) 2016; 95(8)e2859
[] [PMID: 26937917]
Bauer EM, Ben-Artzi A, Duffy EL, et al. Joint-specific assessment of swelling and power Doppler in obese rheumatoid arthritis patients. BMC Musculoskelet Disord 2017; 18(1): 99.
[] [PMID: 28259162]
Alemao E, Guo Z, Iannaccone C, Frits M, Weinblatt M, Shadick N. AT0197 Treatment outcomes with anti-TNF and non-anti-TNF disease-modifying therapy by baseline body mass index. Ann Rheum Dis 2017; 76: 846-7.
Visman IM, van den Oever IA, Krieckaert CL, et al. THU0201 The influence of body mass index on the efficacy of TNF-alpha blocking therapy in rheumatoid arthritis. Ann Rheum Dis 2013; 72: A231-2.
González-Gay MA, González-Juanatey C. Rheumatoid arthritis: Obesity impairs efficacy of anti-TNF therapy in patients with RA. Nat Rev Rheumatol 2012; 8(11): 641-2.
[] [PMID: 23007743]
Gremese E, Carletto A, Padovan M, et al. Obesity and reduction of the response rate to anti–tumor necrosis factor in rheumatoid arthritis: An approach to a personalized medicine. Arthritis Care Res 65: 94-100.2013;
Klaasen R, Wijbrandts CA, Gerlag DM, Tak PP. Body mass index and clinical response to infliximab in rheumatoid arthritis. Arthritis Rheum 2011; 63(2): 359-64.
[] [PMID: 21279992]
Mshimesh B. High body mass index and reduction of response to rituximab in patients with rheumatoid arthritis. IJPSR 2017; 8(2): 621-30.
Baker JF, Østergaard M, George M, et al. Greater body mass independently predicts less radiographic progression on X-ray and MRI over 1-2 years. Ann Rheum Dis 2014; 73(11): 1923-8.
[] [PMID: 25091439]
Westhoff G, Rau R, Zink A. Radiographic joint damage in early rheumatoid arthritis is highly dependent on body mass index Arthritis Rheum 56: 3575-82.2007;
Finckh A, Turesson C. The impact of obesity on the development and progression of rheumatoid arthritis. Ann Rheum Dis 2014; 73(11): 1911-3.
[] [PMID: 25288687]
Sandberg ME, Bengtsson C, Källberg H, et al. Overweight decreases the chance of achieving good response and low disease activity in early rheumatoid arthritis. Ann Rheum Dis 2014; 73(11): 2029-33.
[] [PMID: 24818635]
Goodman S, Yan Ma, Zhang W, et al. Very low or high body mass index negatively affects patients’ ability to achieve sustained remission in early RA in a multicenter canadian cohort. Arthritis Rheumatol 66(S168).2014;
Colebatch AN, Edwards CJ, Østergaard M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis 2013; 72(6): 804-14.
[] [PMID: 23520036]
Grassi W, Cervini C. Ultrasonography in rheumatology: an evolving technique. Ann Rheum Dis 1998; 2003(48): 955-62.
[] [PMID: 9741308]
Backhaus M, Ohrndorf S, Kellner H, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: A pilot project. Arthritis Rheum 2009; 61: 1194-201.
Backhaus TM, Ohrndorf S, Kellner H, et al. The US7 score is sensitive to change in a large cohort of patients with rheumatoid arthritis over 12 months of therapy. Ann Rheum Dis 2013; 72(7): 1163-9.
[] [PMID: 22956596]
Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005; 32(12): 2485-7.
[PMID: 16331793]
Scheel AK, Hermann KG, Kahler E, et al. A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis Arthritis Rheum 52: 733-43.2005;
Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis Arthritis Rheum 48: 955-62.2003;
Balsa A, de Miguel E, Castillo C, Peiteado D, Martín-Mola E. Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard. Rheumatology (Oxford) 2010; 49(4): 683-90.
[] [PMID: 20047979]
Khan A, Sukumaran S, Kanitkar M, Zafar A-S, Shah S, Adnan S. SAT0140 Effect of obesity in response to biologics in rheumatoid arthritis. Ann Rheum Dis 2017; 76: 821-2.
Corp IBM. IBM Corp. IBM SPSS Statistics for Windows, Version 24.0. In: Armonk. 2016.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy