Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Current literature suggests that obesity impacts disease activity in rheumatoid arthritis (RA) and the incidence of obesity is on the rise. The objective of this study was to evaluate how obesity (BMI≥30) affects different composite disease activity measures in RA, specifically evaluating differences between 28 vs 44 joint counts measures.
Methods:
We examined a long-term prospective observational cohort of early poor prognosis seropositive RA patients (within 15 months of symptom onset) from the Western Consortium of Practicing Rheumatologists. Patients included had a diagnosis of RA according to the ACR 1987 criteria, DMARD-naive, positive rheumatoid factor, ≥6 SJC, and ≥9 TJC. BMI was categorized above and below 30. The following baseline characteristics were collected: age, gender, BMI, disease duration, CCP status, prednisone use, sharp scores, and radiographic evidence of osteoarthritis (OA). Components needed to calculate DAS44/ESR-4 item, DAS28/ESR-4 item, and CDAI were also collected at baseline. Patients completed a comprehensive questionnaire at study entry including: demographics, health, medication, pain visual analog scale (VAS), patient global VAS, and the Health Assessment Questionnaire-Disability Index (HAQ-DI).
Results:
Significant difference between obese and non-obese patients were observed for baseline swelling of MCP, knees, ankles, and MTP joints, tender ankle joints, HAQ-DI and MD global. Consequently, DAS44/ESR-4item was significantly higher in the obese early RA patients, but DAS28/ESR4 item and CDAI were not significantly different. Other baseline measures were not different.
Conclusion:
Our results suggest that in obese RA patients, swelling of the LE weight bearing joints may impact composite disease activity measures. DAS44/ESR-4 item (considered a gold standard measure) was significantly different between obese and non-obese RA patients, while the DAS28/ESR-4 item and CDAI were not. Several studies that examined the relationship between BMI and disease activity (Sahebari et al 2011, Klaasen et al 2011, Baker et al 2011), used DAS28 as their measure of disease activity. Our findings suggest that weight bearing joints should be included when assessing RA disease activity in obese patients, and future studies are needed to validate these results.
Table 1 Baseline Values
|
BMI 20-30 (N=184) |
BMI >30 (N=64) |
||
|
mean (SD) |
Mean (SD) |
P-VALUE |
|
|
Age |
51.4 (13.1) |
51.6 (11.4) |
NS |
|
Female |
75.5% |
78.1% |
NS |
|
Duration |
8.16 (8.8) |
6.57 (5.6) |
NS |
|
On MTX |
54.4% |
59% |
NS |
|
Nodules |
0.18 (0.5) |
0.08 (0.3) |
NS |
|
OA present |
36.6% |
37.7% |
NS |
|
ESR |
40 (24.7) |
42.7 (25.3) |
NS |
|
CRP |
2.9 (6.9) |
3.5 (4.1) |
NS |
|
On Pred
|
46.2% |
45.9% |
NS |
|
CDAI |
36.1 (14.4) |
40.8 (16.3) |
NS |
|
HAQ-DI |
1.1 (0.7) |
1.4 (0.7) |
0.005 |
|
das44esr4 |
4.6 (1.2) |
5.1 (1.3) |
0.01 |
|
das28esr4 |
6.1 (1.1) |
6.4 (1.1) |
NS |
|
Pt global |
54.5 (27.7) |
57.9 (25.7) |
NS |
|
MD global |
48.1 (21) |
55.1 (20.3) |
0.03 |
|
Tender28 |
13.5 (7.1) |
14.5 (8.1) |
NS |
|
Tender44 |
20 (9.5) |
21.7 (11.52) |
NS |
|
LE tender |
6.9 (4.3) |
7.2 (4.6) |
NS |
|
UE tender |
13.2 (6.9) |
14.4 (7.9) |
NS |
|
Ankle tender |
0.9 (0.9) |
1.3 (0.9) |
0.004 |
|
Swell28 |
12.5 (6.6) |
14.9 (7.3) |
0.04 |
|
Swell44 |
17.4 (8.6) |
22.2 (10.6) |
0.003 |
|
LE swollen |
5.5 (4.2) |
8 (4.9) |
<.001 |
|
UE swollen |
11.6 (6.2) |
14.4 (7) |
0.008 |
|
MCP swollen |
4.8 (3.2) |
6.2 (3.3) |
0.004 |
|
Knee swollen |
0.8 (0.9) |
1.2 (0.9) |
0.001 |
|
Ankle swollen |
0.8 (0.9) |
1.4 (0.8) |
<.001 |
|
MTP swollen |
4 (3.7) |
5.5 (4.1) |
0.01 |
LE- lower extremity, UE- upper extremity
Disclosure:
V. Garg,
None;
P. Maranian,
None;
M. B. Taylor,
None;
H. E. Paulus,
None;
D. Elashoff,
None;
V. K. Ranganath,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/das28-is-not-a-sufficient-disease-activity-measure-for-obese-rheumatoid-arthritis-patients-dont-leave-the-feet-behind/