Background/Purpose: Obesity is recognized as a systemic, low-grade inflammatory state and the adipose tissue as an endocrine organ releasing pro-inflammatory cytokines. On the other hand, obesity is one of the potentially preventable risk factors for rheumatoid arthritis (RA) being associated with RA onset, disease severity and poor response to therapy (1,2). The aim was to evaluate whether in obese RA patients with a low-moderate disease activity, a weight loss obtained with a controlled nutritional intervention may lead to an improvement of disease activity and to reduce the need of increasing therapeutic regimens, without modifying RA treatment during the study period.

Methods: 63 consecutive obese RA patients (BMI>30 Kg/m2), not in disease remission and with a low-moderate disease activity (1.6<DAS<3.7), in stable therapy with conventional DMARDs (cDMARDs) and/or biological DMARDs (bDMARDs) for at least 12 weeks, were enrolled. All patients underwent a scheduled dietetic regimen under a Nutritionist guide, aimed at a weight loss >5% of the baseline weight at the 6^thmonths (T6) of follow-up, maintaining unchanged the RA therapy. Patients were evaluated by the Rheumatologist and the Nutritionist every 2 months and at each visit clinical and laboratory data and the ACR/EULAR core data set was registered. Disease activity was evaluated by the Disease Activity Score on 44 joints (DAS) and the Simplified Disease Activity Index (SDAI).

Results: Of the 63 RA patients reaching the 6^thmonth FU (82.8% female, age 56.5±12.5 years, disease duration 8.1±8.1 years, 66.9% seropositive, baseline DAS 2.8±0.7, baseline BMI 35.3±4.3), 35 (55.5%) were under cDMARDs-only therapy and 28 (44.5%) under bDMARDs therapy+/- cDMARDs.

At T6, the mean reduction of body weight was 6.7±4.7 Kg (7.3±6.0% of baseline body weight, p<0.01 vs T0) and that of DAS was 0.8±1.0 (DAS T6: 2.0±0.7, p<0.01 vs DAS T0).

Dividing patients according to the percentage of weight loss at T6, the 40 (63.5%) RA patients reaching a weight reduction >5% of the baseline body weight obtained higher rates of DAS remission than patients with a weight reduction <5% (DAS remission at T6: 35.0% vs 9.1%, respectively, p=0.03), as well as of SDAI remission (34.2% vs 4.8%, p=0.01).

The difference was even more significant considering a weight reduction >10%, with a DAS remission at T6 of 55.6% in RA patients reaching >10% of weight reduction with respect to 13.6% in patients not reaching this outcome (p<0.01), and a SDAI remission at T6 of 62.5% and 9.3%, respectively (p<0.01). Results were similar between patients under cDMARDs-only and bDMARDs treatment.

Conclusion: A weight loss obtained with a controlled diet in obese still active RA patients can allow to obtain a better disease control without changing the treatment of RA, and in particular a weight loss >10% permits to reach disease remission in a significant percentage of patients, therefore reducing the need of an increase/modification of therapy. The effects of weight loss based on a nutritional intervention, and so applicable at the population level, on the RA disease course appears to be crucial in terms of potential clinical and pharmacoeconomics perspectives.

References:

1. Crowson CS, Arthritis Care Res 2013

2. Gremese E, Arthritis Care Res 2012

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/weight-loss-in-obese-rheumatoid-arthritis-ra-patients-improves-disease-activity-without-modifying-ra-treatment/