Study: Obese Patients Are Less Likely to Achieve RA Remission

In a new study led by University of Calgary researchers, obese patients with rheumatoid arthritis (RA) demonstrated greater disease activity and were found less likely to achieve remission than non-obese RA patients.

In an effort to summarize the relationship between obesity and remission, other measures of treatment response, and mortality in RA, investigators searched Medline and EMBASE (using relevant MeSH and keyword terms for obesity and RA), selecting articles that reported estimates for achieving remission in obese subjects relative to other body mass index (BMI) categories; changes in composite or individual disease activity measures or patient-reported outcomes during therapy; or mortality rates, in relationship to BMI category or on a continuous scale. Remission outcomes were conducive to meta-analysis, and all other outcomes were summarized, according to the authors.
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Overall, obese RA patients showed 40% lower odds of achieving remission, and were determined to be half as likely to maintain sustained remission. In total, 3368 records were screened, with researchers including 8 reporting remission rates, 9 reporting disease activity measures or patient-reported outcomes, and 3 examining mortality by obesity status or BMI.

Obese patients demonstrated reduced frequency of obtaining remission compared with non-obese patients and/or patients of normal weight. In adjusted models, obese patients showed lower odds of achieving remission and sustained remission relative to non-obese categories, according to the investigators, who noted that most studies found obese patients to have worse disease activity score, tender joint count, inflammatory markers, patient global evaluation, pain, and physical function scores during follow-up, but not swollen joint counts. Obesity was not linked to increased mortality.

The findings demonstrate that "patients with rheumatoid arthritis who were obese, as compared to non-obese patients, were less likely to achieve and sustain remission following medical management," said Gilaad Kaplan, MD, MPH, FRCPC, an associate professor and gastroenterologist at the University of Calgary's Cumming School of Medicine, and a coauthor of the study.

"These data support primary care physicians' effort to tackle the growing problem of obesity among the population," said Dr Kaplan, adding that "our study recommends that future studies evaluate whether weight loss can improve outcomes for patients with rheumatoid arthritis who are obese."

—Mark McGraw

Reference

Liu Y, Hazlewood G, Kaplan GG, et al. The impact of obesity on remission and disease activity in rheumatoid arthritis: a systematic review and meta-analysis [published online May 9, 2016]. Arthritis Care Res. doi:10.1002/acr.22932.