Session Information
Title: Rheumatoid Arthritis - Clinical Aspects: Novel Biomarkers and Other Measurements of Disease Activity
Session Type: Abstract Submissions (ACR)
Background/Purpose: To determine if patients with a very low body mass index (BMI) (<18.5) or high BMI (≥ 25) are able to achieve sustained remission (susREM) in an early RA (ERA) cohort.
Methods: Initial BMI and disease activity (DAS28) were prospectively measured over 3 years in patients from CATCH (Canadian Early Arthritis Cohort). Patients were categorized into 6 groups based on World Health Organization BMI classifications (class 1-6) Differences between BMI groups in patients’ demographics and clinical outcomes were assessed using Chi-square/Fisher’s exact tests or Kruskal-Wallis tests. Multivariate regression based on generalized estimating equations (GEE) methods was used to compare the likelihood of achieving susREM between groups, where susREM was defined as DAS28<2.6 x 2 at consecutive visits 3-12 months apart.
Results: 944/2524 eligible patients with a measured BMI and ≥ 2 consecutively measured DAS28 scores over 3 years formed the study cohort. Only 15 (2%) patients were underweight (category (Cat) 1). Overall 65% were either overweight (34% in Cat 3) or obese (31% in Cat 4-6), representing a rate higher than the WHO reported 47% national average. Patient characteristics in the 6 BMI categories were studied (Table 1). Univariate analysis, presented for BMI strata show patients with higher BMI were older (p<0.0001), more often female (p<.001) with worse function at baseline by HAQ-DI ( p<001). Those with very low or high BMI had a higher CRP (p=0.0004) and ESR (p<0.001), and those with low or normal BMI were more often smokers (p<0.0001). Patients in the highest BMI strata had higher Patient Global Assessments of disease (PtGA) (p=0.03) and pain (p=0.04). Variables that did not differ among groups included Physician's Global assessments (MDGA)(p=0.9), ACPA and RF positivity [(p=0.16)],(p=0.26)], symptom duration (p=0.66), DAS28 (p=0.06) at study entry, or steroid (p=0.3) or methotrexate (MTX) use (p=0.9) over the first 3 months. In the multivariate analysis patients in all BMI categories except for class 4 (p value=0.678 were significantly less likely to achieve susREM compared to normal BMI. Early MTX use, not smoking, being Caucasian and achieving a low disease activity state (LDAS) by 6 months increased the odds of achieving susREM (Table 2).
Conclusion: The chance of achieving sustained remission is decreased in underweight, and overweight / obese ERA patients, more so in the morbidly obese (class 5-6). Early use of MTX, an early response to treatment, and non-smoking status improve the odds of sustained remission independent of BMI. BMI should be considered among the modifiable risk factors for poor RA outcomes.
|
Table 1: Characteristics of ERA patients in CATCH based on WHO BMI Categories (Univariate Analysis) |
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|
WHO Category |
BMI 1 (<18.5) |
BMI 2 (18.5 ≥ and<25) |
BMI 3 (25 ≥ and<30) |
BMI 4 (≥ 30 and<35) |
BMI 5 (≥ 35 and <40) |
BMI 6 (≥ 40) |
|
|
Baseline Variables* |
Underweight |
Normal |
Overweight |
Obese I |
Obese II |
Obese III |
p-Value** |
|
(N=15) |
(N=314) |
(N=323) |
(N=175) |
(N=74) |
(N=42) |
||
|
Age |
47.4 (17.8) |
49.7(16.6) |
55.2 (14.5) |
54.9 (13.2) |
51.5(13.9) |
52.3(10.3) |
0.0001 |
|
DAS28 |
5.4 (1.5) |
4.8 (1.6) |
5.0 (1.5) |
5.1 (1.4) |
5.3(1.5) |
5.2(1.3) |
0.0610 |
|
Female |
16 (100%) |
255 (82%) |
205(64%) |
112(64%) |
57(77%) |
34(81%) |
<.001 |
|
Caucasian |
12 (75%) |
241 (77%) |
264 (82)% |
137(79%) |
58(78%) |
33(78%) |
0.0004 |
|
Smoker*** |
3 (18.8%) |
62 (19.8%) |
55 (17%) |
27(15.4%) |
6(8.1%) |
6(14.3) |
0.0001 |
|
ESR(mm/h) |
42.7(27.8) |
24.9 (24.3) |
27.8 (23.4) |
26 .7 (20.6) |
28.6(22.1) |
31.8(21.7) |
0.0014 |
|
RF |
12 (75%) |
163 (57%) |
187 (63%) |
104(63%) |
36(52%) |
26(65%) |
0.2616 |
|
Anti-CCP |
12 (86%) |
147 (64%) |
149 (67%) |
80(64%) |
29(54%) |
16(53%) |
0.1682 |
|
Caucasian |
12(75%) |
241(77%) |
264(81.7%) |
137(79%) |
58(78%) |
33(78%) |
0.0004 |
|
CRP (U/L) |
18.3(22.6) |
12 (18.1) |
16.8 (21.8) |
13.6 (17.1) |
11.5(13.3) |
17.6(17.8) |
0.0004 |
|
PtGA (0-10) |
5.2(3.3) |
5.6 (3) |
5.8 (2.9) |
6.1(3) |
6.3(2.8) |
6.5(2.4) |
0.1873 |
|
Pain (0-10) |
5(3.2) |
5.2(2.8) |
5.5 (2.9) |
5.5(2.9) |
6.3(2.6) |
6.2(2.3) |
0.0416 |
|
HAQ-DI |
0.8 (0.7) |
0.9 (0.7) |
1.0 (0.7) |
1.0(0.8) |
1.2(0.6) |
1.2(0.7) |
0.0011 |
|
MDGA |
5.3 (2.7) |
5.0 (2.5) |
5.1 (2.5) |
5.0(2.5) |
5.4(2.6) |
5(2.2) |
0.9392 |
|
MTX use |
12 (75%) |
226 (72%) |
243 (75%) |
130(74%) |
55(74%) |
32(76%) |
0.9588 |
|
*Results presented as mean(SD) or n(%); **groups compared using Chi-square/Fisher’s exact tests or Kruskal-Wallis tests; ***current smoker |
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|
Table 2: Multivariate regression (GEE): Both high and low BMI were associated with a lower odds of achieving sustained remission |
||
|
Variables* |
OR (95% CI) |
p-value** |
|
BMI Category 1 vs. 2*** |
0.55 (0.31-0.96) |
0.0361 |
|
BMI Category 3 vs. 2 |
0.75 (0.63-0.90) |
0.0022 |
|
BMI Category 4 vs. 2 |
0.82 (0.67-1.01) |
0.0678 |
|
BMI Category 5 vs. 2 |
0.50 (0.37-0.67) |
<.0001 |
|
BMI Category 6 vs. 2 |
0.36 (0.24-0.53) |
<.0001 |
|
Function (HAQ-Di) 0-3 |
0.54 (0.45-0.64) |
<.0001 |
|
Pain (0-10) |
0.94 (0.89-0.99) |
0.0369 |
|
Achieved LDAS by 6 months (DAS28<3.2) |
5.36 (4.57-6.29) |
<.0001 |
|
Age |
0.98 (0.98-0.99) |
<.0001 |
|
Female Gender |
0.55 (0.46-0.66) |
<.0001 |
|
Non-Caucasian vs. Caucasian |
0.45 (0.35-0.56) |
<.0001 |
|
Never/Ex-Smoker |
1.52 (1.23-1.87) |
<.0.0001 |
|
Received Methotrexate over first 3 months |
1.72 (1.43-2.05) |
<0.0001 |
|
Variables remaining significant using multivariable regression using generalized estimating equations (GEE) controlling for BMI categories, function, pain, LDAS, age, gender, race, income, smoking, MTX use* Statistical significance measured using Chi-Square; ** Comparison of BMI groups where normal BMI is referent *** |
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Disclosure:
S. M. Goodman,
None;
Y. Ma,
None;
W. Zhang,
None;
E. Schulman,
None;
J. E. Pope,
None;
C. Hitchon,
None;
S. J. Bartlett,
None;
B. Haraoui,
AbbVie,
2,
AbbVie,
5,
Amgen,
2,
Amgen,
5,
Bristol-Myers Squibb,
2,
Bristol-Myers Squibb,
5,
Janssen Pharmaceutica Product, L.P.,
2,
Janssen Pharmaceutica Product, L.P.,
5,
Pfizer Inc,
2,
Pfizer Inc,
5,
Roche Pharmaceuticals,
2,
Roche Pharmaceuticals,
5,
UCB,
2,
UCB,
5;
D. Lin,
None;
G. Boire,
None;
D. Tin,
None;
J. C. Thorne,
None;
S. Jamal,
None;
E. C. Keystone,
Abbott Laboratories,
2,
Amgen Canada,
2,
Astrazeneca Pharmaceuticals LP,
2,
Bristo-Myers Squibb,
2,
F. Hoffman La-Roche Inc.,
2,
Janssen Pharmaceutica Product, L.P.,
2,
Eli Lilly and Company,
2,
Novartis Pharmaceutical Corporation,
2,
Pfizer Inc,
2,
Sanofi-Aventis Pharmaceutical,
2,
Abbott Laboratories,
5,
AstraZeneca,
5,
Biotest,
5,
Bristol-Myers Squibb,
5,
F. Hoffman-La Roche Inc.,
5,
Genentech and Biogen IDEC Inc.,
5,
Janssen Pharmaceutica Product, L.P.,
5,
Eli Lilly and Company,
5,
Merck Pharmaceuticals,
5,
Pfizer Inc,
5,
Abbott Laboratories,
8,
AstraZeneca,
8,
Bristol-Myers Squibb,
8,
F. Hoffman La-Roche Inc.,
8,
Janssen Pharmaceutica Product, L.P.,
8,
Pfizer Inc,
8,
UCB,
8,
Amgen,
8;
V. P. Bykerk,
CATCH Sponsors,
9.
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