Background/Purpose: Genetic, demographic, clinical, and immunological factors have been related with the response to treatment in inflammatory rheumatic diseases, such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Among them, obesity and smoking are two potentially modifiable risk factors. Obesity has been associated with persistent activity of the disease and a lower response to TNF inhibitors. Active smoking is associated with disease severity and lower response to conventional treatment. The aim of this study is to evaluate the association of baseline characteristics, particularly obesity, smoking and disease activity in patients with RA and psoriatic PsA using data from the Mexican Adverse Events Registry (BIOBADAMEX).

Methods: In this case-control study from an inception cohort from BIOBADAMEX we included all patients with RA and PsA diagnosis registered from 2016 to April 2023. We compared the clinical characteristics between RA and PsA. Patients were divided in 2 groups: those with remission/low disease activity and those with moderate/high disease activity, patients without disease activity registered were excluded. Sociodemographic, clinical, and treatment characteristics were compared between groups. Chi square and Mann Whitney U tests to analyze differences between the groups. Multivariate model was used to analyze disease activity associated variables.

Results: A total of 818 patients were included, 748 with RA and 70 with PsA. When comparing both groups, we found that PsA patients had higher BMI (29.4 vs 26.7, p = 0.001), lower disease duration (9.7 vs 14.2, p = 0.001) and lower use of steroids (17.1 vs 39.6, p = 0.001). Variables like gender, age, smoking, disease activity, comorbidities were similar (Table 1). When we compared RA patients with remission/low activity and moderate/high activity (Table 2), we found that moderate/high activity patients had lower smoking habit (6.1 vs 9.4, p = 0.007), lower disease duration (13.2 vs 16.1, p = 0.002), and lower use of previous biologic (36.1 vs 62.3, p = 0.001). Comparison between PsA patients with remission/low activity and moderate/high activity (Table 3) showed lower smoking frequency in moderate/high activity (5.3 vs 28, p = 0.03). For the adjusted multivariable analysis, we included age, sex, BMI, smoking, disease duration and previous use of biologic therapy. In RA patients we found that longer disease duration (p = 0.03) and previous use of biologic (p = 0.001) were associated with lower risk of disease activity. In PsA patients we found that smoking habit (p = 0.007) was associated with lower risk of disease activity.

Conclusion: In Mexican RA and PsA patients enrolled in BIOBADAMEX, we found that most of the patients have BMI >25. However, higher BMI did not show an association with disease activity. Further studies comparing BMI levels and activity, as well as comparing Mexican BMI with other regions will be conducted. On the other hand, we found that smoking was associated with lower disease activity, especially in PsA patients. This finding correlates with the Choi HK study where smokers had slower radiographic progression. This finding needs further investigation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-and-predictors-of-disease-activity-in-rheumatoid-arthritis-and-psoriatic-arthritis-data-from-the-mexican-adverse-events-registry-biobadamex/