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Obese patients with early RA less likely to achieve remission, study suggests

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People who are overweight may be less likely to achieve sustained remission in early rheumatoid arthritis (RA), according to new research.

A study published in Arthritis Care & Research examines how excess weight and obesity may affect the likelihood of achieving remission in the early years after an RA diagnosis.

“Our study looks at people with recently diagnosed, early RA, who should have the best outcomes and best responses to treatment, and sees how many are either overweight or obese, and then determines if those who are overweight or obese have worse outcomes than those with healthy weight,” explained Dr Susan Goodman, of the Hospital for Special Surgery and Weill Cornell Medical School.

Of 982 patients in the Canadian Early Arthritis Cohort, a multicentre observational trial, 32% had a healthy BMI, 35% were overweight, and 33% were obese. Within three years, 36% of patients experienced sustained remission. Compared with patients with a healthy BMI, those who were overweight were 25% less likely to experience sustained remission, and those who were obese were 47% less likely to do so, despite receiving similar treatments.

“These findings have important implications for clinical care since rates of overweight and obesity continue to rise,” Dr Goodman said. “Our findings highlight the high proportion of newly diagnosed RA patients who are overweight or obese and who may have disease that is harder to treat. For people with RA who haven’t had an adequate response to treatment, this may be another factor to consider.”

A separate study published in Arthritis & Rheumatology investigates whether weight change in the early stages of RA is associated with a subsequent risk of early death.

Dr Jeffrey Sparks, of Brigham and Women’s Hospital and Harvard Medical School, and his colleagues evaluated data on 902 women diagnosed with RA in the Nurses’ Health Study and 7,884 matched women without RA.

They found that women with RA had higher mortality rates overall than women without RA. Those who lost a considerable amount of weight (>30 pounds) had the highest mortality rates in both patient groups, while a weight gain of >30 pounds had no association with mortality.

“Our study is the first to focus on weight change around RA diagnosis and risk of death, rather than weight change in patients who had RA for many years, as in previous studies,” said Dr Sparks. “Our findings provide evidence that the results of earlier studies — that patients who had normal weights were at higher risk of death — may have been related to unintended weight loss as opposed to a protective effect of being overweight or obese. Our results demonstrate that these prior findings were less likely to be directly related to RA and were likely a phenomenon of frailty and ageing of the general population.”

http://newsroom.wiley.com/press-release/arthritis-care-research/studies-examine-effects-weight-patients-rheumatoid-arthritis

http://onlinelibrary.wiley.com/doi/10.1002/acr.23457/abstract

http://onlinelibrary.wiley.com/doi/10.1002/art.40346/abstract