Session Type: Abstract Submissions (ACR)
Background/Purpose: Overweight and obesity in patients with rheumatoid arthritis (RA) are rising conditions. Adipose tissue has pro inflammatory properties by producing adipokines which could play a role in RA activity. The prognosis of overweight and obese patients with RA is not well established.
Methods: We conducted a systematic review and meta-analysis to assess the influence of body mass index on disease activity (DAS 28) and radiographic joint damage (RJD) in patients with RA. We searched MEDLINE and The Cochrane Database publications up to April 2014 with MeSH terms (“body mass index” OR “obese”) AND “rheumatoid arthritis”. Studies reporting DAS 28 and/or its components,Health Assesment Questionnaire (HAQ) and RJD according to body mass index (BMI)groups were included. Two investigators abstracted data and rated study quality and applicability. Statistical analysis used weighted mean differences with a fixed or random effects model, except for radiographic analysis in which standardized means were used as different radiographic scores were assessed in studies.
Results: Among the 579 citations retrieved with MeSH terms, 52 articles suited inclusion criteria and 7 of them were included in meta-analysis. Activity was assessed in 4 studies, involving 1402 patients, and revealed an association between obesity in RA and higher DAS 28 (+ 0.14, p=0.04, I²=0%).Health Assessment Questionnaire (HAQ) was evaluated in 2 studies, involving 1264 patients, and also revealed a positive association with obesity (+ 0.1, p=0.03, I²=0%). RJD was reported in 4 studies, involving 1465 patients, revealing a negative association with obesity (p=0.03, I²=38%). According to the systematic review, the increase of DAS 28 could be explained by an increase of tender joint counts and global health assessment.
Conclusion: Obesity in RA is associated with higher DAS 28 and HAQ. However, obese patients with RA have lower RJD. This increase of DAS28 in obese patients could be explained by pro inflammatory fat cytokines or the general tendency of higher pain levels due to comorbidities resulting from obesity. Conversely, the increase of adiponectine observed in obese patients may play a protective role on joint damage. Altogether, this work highlights the importance of obesity on RA prognosis and supports the need of future studies to better understand the mechanisms behind.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/influence-of-body-mass-index-on-disease-activity-and-radiographic-joint-damage-in-rheumatoid-arthritis-a-systematic-review-and-meta-analysis/