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Abstract Number: 394

Very Low or High Body Mass Index Negatively Affects patients’ Ability to Achieve Sustained Remission in Early RA in a Multicenter Canadian Cohort

Susan M. Goodman1, Yan Ma2, Wei Zhang3, Elizabeth Schulman4, Janet E. Pope5, Carol Hitchon6, Susan J. Bartlett7, Boulos Haraoui8, Daming Lin9, Gilles Boire10, Diane Tin11, J. Carter Thorne12, Shahin Jamal13, Edward C. Keystone14 and Vivian P. Bykerk1,15, 1Rheumatology, Hospital for Special Surgery, New York, NY, 2Research - Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, 3Healthcare Research Institute, Hospital for Special Surgery, New York, NY, 4Rheumatology, New York Presbyterian - Cornell Campus - HSS, New York, NY, 5St Joseph Health Care, London, ON, Canada, 6Rheumatology, University of Manitoba, Winnipeg, MB, Canada, 7Division of Rheumatology, Johns Hopkins University, Baltimore, MD, 8University of Montreal Hospital Centre, Montreal, QC, Canada, 9Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 10Rheumatology Division, CHUS - Sherbrooke University, Sherbrooke, QC, Canada, 11The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 12Southlake Regional Health Centre, Newmarket, Newmarket, ON, Canada, 13Vancouver General Hospital, Vancouver, BC, Canada, 14Medicine, University of Toronto, Toronto, ON, Canada, 15Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: body mass, Early Rheumatoid Arthritis, multicenter study and rheumatoid arthritis (RA)

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Session Information

Title: Rheumatoid Arthritis - Clinical Aspects: Novel Biomarkers and Other Measurements of Disease Activity

Session Type: Abstract Submissions (ACR)

Background/Purpose: To determine if patients with a very low body mass index (BMI) (<18.5) or high BMI (≥ 25) are able to achieve sustained remission (susREM) in an early RA (ERA) cohort.

Methods: Initial BMI and disease activity (DAS28) were prospectively measured over 3 years in patients from CATCH (Canadian Early Arthritis Cohort).  Patients were categorized into 6 groups based on World Health Organization BMI classifications (class 1-6) Differences between BMI groups in patients’ demographics and clinical outcomes were assessed using Chi-square/Fisher’s exact tests or Kruskal-Wallis tests. Multivariate regression based on generalized estimating equations (GEE) methods was used to compare the likelihood of achieving susREM between groups, where susREM was defined as DAS28<2.6 x 2 at consecutive visits 3-12 months apart.

 

Results: 944/2524 eligible patients with a measured BMI and ≥ 2 consecutively measured DAS28 scores over 3 years formed the study cohort. Only 15 (2%) patients were underweight (category (Cat) 1). Overall 65% were either overweight (34% in Cat 3) or obese (31% in Cat 4-6), representing a rate higher than the WHO reported 47% national average. Patient characteristics in the 6 BMI categories were studied (Table 1). Univariate analysis, presented for BMI strata show patients with higher BMI were older (p<0.0001), more often female (p<.001) with worse function at baseline by HAQ-DI ( p<001). Those with very low or high BMI had a higher CRP (p=0.0004) and ESR (p<0.001), and those with low or normal BMI were more often smokers (p<0.0001). Patients in the highest BMI strata had higher Patient Global Assessments of disease (PtGA) (p=0.03) and pain (p=0.04). Variables that did not differ among groups included Physician's Global assessments (MDGA)(p=0.9), ACPA and RF positivity [(p=0.16)],(p=0.26)], symptom duration (p=0.66), DAS28  (p=0.06) at study entry, or steroid (p=0.3) or methotrexate (MTX) use (p=0.9) over the first  3 months. In the multivariate analysis patients in all BMI categories except for class 4 (p value=0.678 were significantly less likely to achieve susREM compared to normal BMI. Early MTX use, not smoking, being Caucasian and achieving a low disease activity state (LDAS) by 6 months increased the odds of achieving susREM (Table 2).

Conclusion: The chance of achieving sustained remission is decreased in underweight, and overweight / obese ERA patients, more so in the morbidly obese (class 5-6). Early use of MTX, an early response to treatment, and non-smoking status improve the odds of sustained remission independent of BMI.  BMI should be considered among the modifiable risk factors for poor RA outcomes.

 

Table 1: Characteristics of ERA patients in CATCH based on WHO BMI Categories (Univariate Analysis)

WHO Category

BMI 1

(<18.5)

BMI 2 (18.5 ≥ and<25)

BMI 3

(25 ≥ and<30)

BMI 4

(≥ 30

and<35)

BMI 5

(≥ 35

and <40)

BMI 6

(≥ 40)

 

Baseline

Variables*

Underweight

Normal

Overweight

Obese I

Obese II

Obese III

p-Value**

(N=15)

(N=314)

(N=323)

(N=175)

(N=74)

(N=42)

Age

47.4 (17.8)

49.7(16.6)

55.2 (14.5)

54.9 (13.2)

51.5(13.9)

52.3(10.3)

0.0001

DAS28

5.4 (1.5)

4.8 (1.6)

5.0 (1.5)

5.1 (1.4)

5.3(1.5)

5.2(1.3)

0.0610

Female

16 (100%)

255 (82%)

205(64%)

112(64%)

57(77%)

34(81%)

<.001

Caucasian

12 (75%)

241 (77%)

264 (82)%

137(79%)

58(78%)

33(78%)

0.0004

Smoker***

3 (18.8%)

62 (19.8%)

55 (17%)

27(15.4%)

6(8.1%)

6(14.3)

0.0001

ESR(mm/h)

42.7(27.8)

24.9 (24.3)

27.8 (23.4)

26 .7 (20.6)

28.6(22.1)

31.8(21.7)

0.0014

RF

12 (75%)

163 (57%)

187 (63%)

104(63%)

36(52%)

26(65%)

0.2616

Anti-CCP

12 (86%)

147 (64%)

149 (67%)

80(64%)

29(54%)

16(53%)

0.1682

Caucasian

12(75%)

241(77%)

264(81.7%)

137(79%)

58(78%)

33(78%)

0.0004

CRP (U/L)

18.3(22.6)

12 (18.1)

16.8 (21.8)

13.6 (17.1)

11.5(13.3)

17.6(17.8)

0.0004

PtGA (0-10)

5.2(3.3)

5.6 (3)

5.8 (2.9)

6.1(3)

6.3(2.8)

6.5(2.4)

0.1873

Pain (0-10)

5(3.2)

5.2(2.8)

5.5 (2.9)

5.5(2.9)

6.3(2.6)

6.2(2.3)

0.0416

HAQ-DI

0.8 (0.7)

0.9 (0.7)

1.0 (0.7)

1.0(0.8)

1.2(0.6)

1.2(0.7)

0.0011

MDGA

5.3 (2.7)

5.0 (2.5)

5.1 (2.5)

5.0(2.5)

5.4(2.6)

5(2.2)

0.9392

MTX use

12 (75%)

226 (72%)

243 (75%)

130(74%)

55(74%)

32(76%)

0.9588

*Results presented as mean(SD) or n(%); **groups compared using Chi-square/Fisher’s exact tests or Kruskal-Wallis tests; ***current smoker

 

Table 2: Multivariate regression (GEE): Both high and low BMI were associated with a lower odds of achieving sustained remission

Variables*

OR (95% CI)

p-value**

BMI Category 1 vs. 2***

0.55 (0.31-0.96)

0.0361

 BMI Category 3 vs. 2

0.75 (0.63-0.90)

0.0022

 BMI Category 4 vs. 2

0.82 (0.67-1.01)

0.0678

 BMI Category 5 vs. 2

0.50  (0.37-0.67)

<.0001

 BMI Category 6 vs. 2

0.36 (0.24-0.53)

<.0001

Function (HAQ-Di) 0-3

0.54 (0.45-0.64)

<.0001

Pain (0-10)

0.94 (0.89-0.99)

0.0369

Achieved LDAS by 6 months (DAS28<3.2)

5.36 (4.57-6.29)

<.0001

Age

0.98 (0.98-0.99)

<.0001

Female Gender

0.55 (0.46-0.66)

<.0001

Non-Caucasian vs. Caucasian

0.45 (0.35-0.56)

<.0001

Never/Ex-Smoker

1.52 (1.23-1.87)

<.0.0001

Received Methotrexate over first 3 months

1.72 (1.43-2.05)

<0.0001

Variables remaining significant using multivariable regression using generalized estimating equations (GEE) controlling for BMI categories, function, pain, LDAS, age, gender, race, income, smoking, MTX use* Statistical significance measured using Chi-Square; ** Comparison of BMI groups where normal BMI is referent ***

 


Disclosure:

S. M. Goodman,
None;

Y. Ma,
None;

W. Zhang,
None;

E. Schulman,
None;

J. E. Pope,
None;

C. Hitchon,
None;

S. J. Bartlett,
None;

B. Haraoui,

AbbVie,

2,

AbbVie,

5,

Amgen,

2,

Amgen,

5,

Bristol-Myers Squibb,

2,

Bristol-Myers Squibb,

5,

Janssen Pharmaceutica Product, L.P.,

2,

Janssen Pharmaceutica Product, L.P.,

5,

Pfizer Inc,

2,

Pfizer Inc,

5,

Roche Pharmaceuticals,

2,

Roche Pharmaceuticals,

5,

UCB,

2,

UCB,

5;

D. Lin,
None;

G. Boire,
None;

D. Tin,
None;

J. C. Thorne,
None;

S. Jamal,
None;

E. C. Keystone,

Abbott Laboratories,

2,

Amgen Canada,

2,

Astrazeneca Pharmaceuticals LP,

2,

Bristo-Myers Squibb,

2,

F. Hoffman La-Roche Inc.,

2,

Janssen Pharmaceutica Product, L.P.,

2,

Eli Lilly and Company,

2,

Novartis Pharmaceutical Corporation,

2,

Pfizer Inc,

2,

Sanofi-Aventis Pharmaceutical,

2,

Abbott Laboratories,

5,

AstraZeneca,

5,

Biotest,

5,

Bristol-Myers Squibb,

5,

F. Hoffman-La Roche Inc.,

5,

Genentech and Biogen IDEC Inc.,

5,

Janssen Pharmaceutica Product, L.P.,

5,

Eli Lilly and Company,

5,

Merck Pharmaceuticals,

5,

Pfizer Inc,

5,

Abbott Laboratories,

8,

AstraZeneca,

8,

Bristol-Myers Squibb,

8,

F. Hoffman La-Roche Inc.,

8,

Janssen Pharmaceutica Product, L.P.,

8,

Pfizer Inc,

8,

UCB,

8,

Amgen,

8;

V. P. Bykerk,

CATCH Sponsors,

9.

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