Background/Purpose: Rheumatoid arthritis (RA) is characterized by early, accelerated atherosclerosis leading to increased disability, morbidity and mortality. Inflammation and traditional cardiovascular (CVD) risk factors contribute to poor outcomes, and obesity further increases risks of CVD, diabetes and disability. New sex-specific RA cutpoints for obesity have been proposed. We estimated the prevalence of obesity among Canadian RA patients using the existing and new thresholds.

Methods: Patients receiving care during 2011-13 at two university centers were included. Height and weight were measured and selected demographic (age, sex, tobacco use), RA (duration, RF+, CCP+, ESR, CRP, tender + swollen joints) and patient reported outcomes (patient global, HAQ, morning stiffness) were obtained at the visit. Patients were classified according to WHO criteria and proposed new RA cutpoints, and results were compared with 2008 StatsCan data.

Results: Participants were 200 RA patients (106 from Winnipeg, 94 from Montreal) who were mostly female (76%) with a mean ± SD age of 56.9 ± 15.3 yr, median [IQR] RA duration of 5 [6] yr (29% < 2 yrs) and HAQ of .7 [IQR 1]. 83% were RF+ and 63% anti-CCP+. Groups did not differ between sites by age, sex or BMI, however, patients in Montreal were more likely to have early RA (38 vs 20%; p =.001) and less likely to have smoked (31% vs. 66%, p <.001).  Women were significantly younger than men (56 ± 16 vs 61 ± 14; p=.025) and less likely to report tobacco use (47 vs. 68%; p=.023). RA duration, HAQ and BMI was similar between sexes. Using WHO, 34% of the RA patients were obese; women with RA had higher rates of obesity than men (see table). Using the proposed RA cutpoints, 55% were classified as obese, and men with RA had higher rates of obesity than women. Demographic and RA characteristics were not significantly (p>.05) different between obese and non-obese patients. Although HAQ was only weakly associated with BMI (r=.311 p< .001), obese patients had more than twice the odds of HAQ scores ≥ 1 (OR 2.3 95% CI 1.2, 4.2).

Conclusion: Our results suggest that Canadian RA patients are more likely to be obese than their peers and men appear to be at particular risk. Obesity in RA is associated with greater rates of self-reported disability. Identifying and addressing obesity among newly and established RA patients may be relevant to reduce the excess CVD-associated morbidity and mortality associated with this disease.

 

	All	Men	Women
Canadian Population (2008)	24.1%	24.3%	23.9%
Rheumatoid Arthritis
BMI ≥ 30	34%	29%	36%
Risk Ratio (95 Confidence         Interval)	1.4 (0.9 – 2.2)	1.2 (0.8, 1.9)	1.5 (1.0, 2.3)
Proposed RA Cutpoints
BMI ≥ 24.7 men; 26.1 women	55%	67%	53%
Risk Ratio	2.3 (1.5, 3.4)	2.8 (1.9, 4.1)	2.2 (1.5, 3.3)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-prevalence-of-obesity-among-early-and-established-rheumatoid-arthritis/