ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 3068

Smoking and Excess Weight Attenuate Rate of Improvement over First 3 Years in Early RA

Susan J. Bartlett1,2, Orit Schieir3, Kathleen Andersen4, Gilles Boire5, Boulos Haraoui6, Carol Hitchon7, Edward Keystone8, Janet E. Pope9, J Carter Thorne10, Diane Tin11, Vivian P. Bykerk12 and Canadian Early Arthritis Cohort (CATCH) Investigators, 1Department of Medicine, Division of ClinEpi, Rheumatology, Respirology, McGill University, Montreal, QC, Canada, 2Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, 3University of Toronto, Toronto, ON, Canada, 4Rheumatology, Hospital for Special Surgery, New York, NY, 5Rheumatology Division, CHUS - Sherbrooke University, Sherbrooke, QC, Canada, 61551, Ontario Street East, Institut de Recherche en Rhumatologie de Montréal (IRRM), Montreal, QC, Canada, 7University of Manitoba, Winnipeg, MB, Canada, 8Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada, 9University of Western Ontario, St Joseph's Health Care, London, ON, Canada, 10Southlake Regional Health Centre, Newmarket, ON, Canada, 11The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 12Divison of Rheumatology, Hospital for Special Surgery, New York, NY

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: , ,

Session Information

Date: Tuesday, November 15, 2016

Title: Epidemiology and Public Health II: Obesity, Cancer and Mortality

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Early, aggressive treatment to achieve remission is the primary goal when treating early RA, and is associated with improved long-term outcomes. We have previously shown that individuals who smoke and have excess weight (potentially modifiable factors) are less likely to achieve sustained remission in the first 3 years. Here we explore how smoking, excess weight, and sex affect rate of DAS28 improvement in the first 3 years of early RA.

Methods: Data were drawn from a multicenter prospective cohort study of ERA patients seen in usual care settings. Inclusion criteria were: meeting 1987 or 2010 ACR criteria, <12 months symptom duration at entry, DAS28≥2.6 at entry, and information on BMI and DAS28 at baseline and at least 1 follow up visit. Patients were followed every 3 months in year 1, 6 months in year 2, and annually thereafter. We examined how sex, excess weight (overweight: BMI 25-29.9; obese: BMI 30+) and smoking (current/former/never) impacted DAS28 at baseline and over time using linear growth models. Covariates included baseline age, race, education, comorbidities, symptom duration, and treatment.

Results: The sample included 1109 patients with a mean [SD] age of 54 [15], symptom duration of 6 [3] months; most were female (n=795; 72%) and white (n=893; 81%). Among males 44% (n=138) were overweight, 35% (n=109) were obese and 22% (n=70) smoked; among females, 31% (n=248) were overweight, 32% (n=257) were obese, and 15% (n=121) smoked. At enrollment, most (n=810; 73%) were on MTX. Results of the growth curve model without covariates showed that average DAS28 at baseline was moderate to high (random average DAS28: 4.6, 95% CI: 2.7, 6.2), and DAS28 dropped significantly at each time point (random mean rate of change per visit: b -0.33 (95% CI: -0.60, -0.07). Sex, excess weight, and smoking were not significantly associated with baseline DAS28 (p>0.05). However, each attenuated the rate of DAS28 change over time. The average rate of improvement in DAS28 was lower in women vs men (b: 0.09; 95% CI: 0.05-0.12); those who were overweight (b: 0.05; 95% CI: 0.01-0.09) and obese (b:0.09; 95% CI: 0.05-0.13) vs. healthy weight, and current smokers vs. non-smokers (b:0.07; 95% CI: 0.03-0.12), at each time point. Former smoking did not significantly impact DAS28 trajectory (b:0.03; 95% CI: -0.01-0.06).

Conclusion : Results from a large multi-center ERA cohort study showed that sex, excess weight and smoking significantly attenuated the rates of improvement in RA disease activity over the first 3 years. Improvement among former smokers was similar to those who had never smoked. These results contribute to growing evidence of how lifestyle also may impact treatment outcomes and the potential value of referring patients to proven community-based smoking cessation and weight management programs.

 

Disclosure: S. J. Bartlett, None; O. Schieir, None; K. Andersen, None; G. Boire, None; B. Haraoui, None; C. Hitchon, None; E. Keystone, Abbott, Amgen, AstraZeneca, BMS, Hoffman-LaRoche, Janssen, Eli Lilly and Company, Novartis, Pfizer, Sanofi-Aventis, UCB, 2,Abbott, AstraZeneca, Biotest, BMS, Crescendo, Hoffmann-LaRoche, Genentech, Janssen, Eli Lilly and Company, Merck, Pfizer, UCB, 5,Abbott, AstraZeneca, BMS Canada, Hoffmann-LaRoche, Janssen, Pfizer, UCB, Amgen, 9; J. E. Pope, AbbVie, Actelion, Amgen, BMS, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, UCB, 5; J. C. Thorne, Janssen Inc., 5; D. Tin, None; V. P. Bykerk, AbbVie, Bristol-Myers Squibb, Pfizer, Roche/Genentech, Regeneron, and UCB Pharma, 5.

To cite this abstract in AMA style:

Bartlett SJ, Schieir O, Andersen K, Boire G, Haraoui B, Hitchon C, Keystone E, Pope JE, Thorne JC, Tin D, Bykerk VP. Smoking and Excess Weight Attenuate Rate of Improvement over First 3 Years in Early RA [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/smoking-and-excess-weight-attenuate-rate-of-improvement-over-first-3-years-in-early-ra/. Accessed .

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