Obesity in Rheumatoid Arthritis Patients Might Hasten Disability

Obesity in Rheumatoid Arthritis Patients Might Hasten Disability

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Highlights:
  • A study involving adults with rheumatoid arthritis has found that patients who were severely obese experienced more rapidly progressing disability than patients who were overweight.
  • The study also implicates that patients who lost weight after enrolling in the study had worsening disability.
  • Patients with rheumatoid arthritis and obesity might benefit from intentional weight loss through a comprehensive management strategy.
Severely obese rheumatoid arthritis (RA) patients experienced more rapidly progressing disability than overweight patients, says a study on adults with the condition. The disability was not due to signs of arthritis like the amount of inflammation in their joints. Also, the weight loss that occurred after the patients enrolled in the study was also associated with worsening disability, possibly as a sign of frailty.
Obesity in Rheumatoid Arthritis Patients Might Hasten Disability

The study results are published online in Arthritis Care & Research.

Earlier Studies on Weight Change and RA

Two earlier studies had also studied the effects of weight change around RA diagnosis and risk of death.

The first study looked at people who were recently diagnosed with early RA and wanted to determine if being overweight or obese have worse outcomes than healthy weight. The results showed that overweight and obese patients were less likely to experience sustained remission or decreased severity of the condition, compared with patients with a healthy BMI, despite receiving similar treatments.

The second study evaluated the effect of weight change in the early stages of RA on subsequent mortality risk. Women who had severe weight loss (>30 pounds) had the highest mortality rates after the early RA period.

According to new research findings presented at the 2017 ACR/ARHP Annual Meeting in San Diego, study author Dr. Nikiphorou said that both obesity and higher RA disease activities increased a patient's odds of higher disability and decreased the rates of remission. There is a growing recognition that the inflammatory states mediated by obesity and those by inflammatory rheumatic diseases share common pathways.

Current Study - Effects of Obesity in Patients with RA

Joshua Baker, MD, MSCE, of the Perelman School of Medicine at the University of Pennsylvania, and his colleagues analyzed information collected on 23,323 patients with rheumatoid arthritis from the National Data Bank of the Rheumatic Diseases and data on 1697 patients from the Veterans Affairs RA registry.

Results of the Study

  • There is more rapid progression of disability, if the patient has severe obesity
  • When patients (especially those who were already lean) lost weight they tended to become disabled more quickly.
The study authors are concluding that this weight loss is unintentional and is the kind that occurs when people get older and acquire illnesses.

"So, this study suggests that patients with rheumatoid arthritis and obesity would benefit from intentional weight loss through a comprehensive management strategy; however, when we see that someone is losing weight without trying, it's probably a poor prognostic sign, especially if they are already thin." said Dr. Baker.

Relevance of the Study

Obesity rates have been rising in recent years. Hence, patients and rheumatologists, apart from focusing on disease activity, should also consider that this common condition can contribute to problems that are usually attributed to the arthritis itself.

Also, unintentional weight loss should be looked as a red flag to indicate that the patient may be becoming frail and is at risk for developing a new disability.

The findings can promote using new therapies and approaches to weight loss in patients with arthritis, to help prevent disability over the long-term.

Health providers might be encouraged to recognize unintentional weight loss as a poor prognostic sign and refer patients for strength training, physical therapy, and other interventions to prevent disability.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease where the body's immune system unintentionally attacks the joints. This causes thickening of the tissue that lines the inside of joints (the synovium), resulting in swelling and pain in and around the joints. RA affects 1.5 million people in the United States alone and is more common in women than in men.

References:
  1. Joshua F. Baker, Bryant R. England, Ted R. Mikuls, Harlan Sayles, Grant W. Cannon, Brian C. Sauer, Michael D. George, Liron Caplan, and Kaleb Michaud. "Obesity, Weight Loss, and Progression of Disability in Rheumatoid Arthritis." Arthritis Care & Research; Published Online: April 30, (2018) DOI: 10.100/acr.23579.
  2. Elizabeth Schulman, Susan J. Bartlett, Orit Schieir, Kathleen M. Andersen, Gilles Boire, Janet E. Pope, Carol Hitchon, Shahin Jamal, J. Carter Thorne, Diane Tin, Edward C. Keystone, Boulos Haraoui, Susan M. Goodman, and Vivian P. Bykerk. "Overweight and Obesity Reduce the Likelihood of Achieving Sustained Remission in Early Rheumatoid Arthritis: Results from the Canadian Early Arthritis Cohort Study." Arthritis Care & Research; Published Online: November 30, (2017)  DOI: 10.1002/acr.23457.


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