High BMI Hinders Remission in Early RA

Those with early rheumatoid arthritis are at a disadvantage if they have a high body mass index. Past studies associated a worse disease severity and lower rates of sustained remission for those patients. But does it take longer to get to a sustained remission for patients with increased body mass versus their thinner counterparts?[[{"type":"media","view_mode":"media_crop","fid":"43490","attributes":{"alt":"©CLIPAREACustommedia/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_5138158621266","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4747","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"","typeof":"foaf:Image"}}]]

In a presentation given on Nov. 10 at the 2015 ACR/ARHP annual meeting in San Francisco, Elizabeth Shulman of the Hospital for Special Surgery in New York, presented results from her co-authored study on this question. Using data from the multicenter Canadian Early Arthritis Cohort study (CATCH), all study patients had rheumatoid arthritis symptoms for 12 months or less that met American College of Rheumatology 1987 and/or 2010 RA criteria, and had at least two consecutive DAS-28 measurements meeting criteria.

The 1,066 early rheumatoid arthritis subjects were divided into three body mass index groups: the normal group (BMI 18.5-24.9) with 33% of the subjects, the overweight group (25-29.9) with 35% of subjects and the obese group (30+) with 33% of the subjects. The time to sustained remission was measured from the first visit until the patient met DAS28≤2.6 at two consecutive visits.

Researchers found that the subjects in both the overweight and obese groups were less likely to achieve sustained remission quickly, compared to the normal body mass index group (HR=0.75, p=0.03 and HR=0.63, p=0.0008). Subjects had a better chance at achieving sustained remission if they had: higher education (1.608, p=0.05), achieved DAS28≤3.2 by six months (HR 4.209, p<0.01), and used methotrexate in the first three months (1.401, p=0.02). Those who were less likely to achieve sustained remission had a higher body mass index, had comorbidities (0.911, p<0.01), and used steroids in the first three months (0.761, p=0.01). One study conclusion was that early rheumatoid arthritis patients with high body mass index not only had lower rates of sustained remission, but took longer to achieve it.

“Being overweight or obese appears to be a factor contributing to suboptimal disease control in early rheumatoid arthritis,” Shulman said in an interview. “Clinicians should consider integrating weight management discussions into their treatment plans with patients to optimally treat them.”

In terms of medication use, the study showed that methotrexate use of at least 15 mg for three months is an independent factor increasing the probability of achieving sustained remission over time, even in obese patients. It also showed that early steroid use decreased the probability of achieving sustained remission. But Shulman said she can’t recommend that physicians change treatment based on solely on these findings.

“Given the observational nature of our study, this may represent confounding by indication. Patients who present with more severe disease that need rapid control of signs and symptoms are more likely to receive steroids,” she said. “Early use of steroids may be an indicator that patients are presenting with more active disease, that these are being used in a treat-to-target model, but that they may delay using other treatment strategies.” However in their cohort, they did not see that steroids provided enough of a disease modifying effect in patients who were prescribed steroids, she said.

The study was funded through unrestricted grants from Canadian Arthritis Network, Amgen, Abbvie, BMS, Janssen, Medexus, Roche and UCB, and some of the investigators are also funded by the Canadian Institute of Health Research and the NIH.

References:

"High Body Mass Index Negatively Impacts Time to Achieving Sustained Remission in Early Rheumatoid Arthritis: Results from a Multicenter Early Arthritis Cohort Study," Elizabeth Schulman. Nov. 10, 2015.  ACR/ARHP 2015.