Patients with PsA and Comorbid Obesity Less Likely to be in Remission

Patients with psoriatic arthritis (PsA) and comorbid obesity were 2.5 – 3 folds less likely to be in remission or low disease activity (LDA) by composite scores when compared with nonobese patients, according to a study published in Rheumatic and Musculoskeletal Diseases.¹ However, the remission and LDA rates were comparable based on the patients’ opinion. Investigators emphasized patients with comorbid obesity may have different disease profiles and require personalized management of their condition.

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Obesity is recognized as an important comorbidity among this patient population. Additionally, it is more prevalent in patients with PsA when compared with the general population or those with rheumatoid arthritis and may be linked to an increased risk of developing PsA among patients with psoriasis. This diagnosis may be associated with a sedentary lifestyle due to musculoskeletal inflammation, pain, and psychological stress from skin disease.²

“A few studies have indicated that patients with obesity may be less likely to achieve remission,” wrote a group of international investigators. “Furthermore, weight reduction may improve the achievement of remission for those initiating biological therapies. However, little is known on the effect of obesity on reaching remission/LDA when defined by indices and patients’ opinion.”

Baseline data from Remission/Flare in PsA (ReFlaP; NCT03119805), an international multi-center cohort study, was used to evaluate adult patients with PsA from 14 countries. Investigators recruited patients with a PsA duration of ≥2 years and information including demographics, comorbidities, clinical data, and patient-reported outcomes were obtained. Physician-reported and/or a body mass index (BMI) of ≥30 kg/m² was used to define obesity. Remission or LDA was categorized as Very Low Disease Activity (VLDA), minimal disease activity (MDA), Disease Activity in Psoriatic Arthritis (DAPSA) ≤4/≤14, or by the patient’s opinion. The link between obesity and the presence of either remission or LDA was determined with adjustments in multivariable regression models.

Of the approximately half (49.3%, n = 431) of patients included in the study, 31.6% (n = 136) were obese. Patients categorized as obese were older, more frequently women, had worse pain, physical function, and health-related quality of life, and had higher tender joint and enthesitis counts when compared with nonobese patients.

Patients with obesity were less likely to be in VLDA, DAPSA remission, and MDA with adjusted odds ratios (ORs) of .31(95% confidence interval [CI] .13 to .77); .39 (95% CI .19 to .80), and .61 (95% CI .38 to .99), respectively. However, the rates of DAPSA-LDA and patient-reported remission and LDA were similar among obese and nonobese patients.

Investigators noted limitations including the choice to recruit patients from tertiary referral centers, which may have hindered the generalizability of the results. Additionally, the cross-sectional analysis did not allow the study to evaluate changes in remission status or casualty. The small sample size of patients also precluded longitudinal analysis. Information collected did not exclude patients with obesity and high disease activity at baseline, who may have been effectively treated with a treat-to-target strategy. Variables, including fibromyalgia, were unaccounted for and may have been an important interaction with obesity. Lastly, obesity was defined as either clinician report or BMI, which may have led to a certain number of discrepancies.

“PsA patients with concurrent obesity had lower odds of being in remission by indices, highlighting the importance of managing obesity to improve the care of patients with PsA,” investigators concluded. “Shared decision-making is important for an individualized target of management.”

References

1. ^{Leung YY, Eder L, Orbai AM, Coates LC, de Wit M, Smolen JS, Kiltz U, Palominos P, Canete JD, Scrivo R, Balanescu A, Dernis E, Meisalu S, Soubrier M, Kalyoncu U, Gossec L. Association between obesity and likelihood of remission or low disease activity status in psoriatic arthritis applying index-based and patient-based definitions of remission: a cross-sectional study. RMD Open. 2023 Sep;9(3):e003157. doi: 10.1136/rmdopen-2023-003157. PMID: 37709527; PMCID: PMC10503343.}
2. ^{Setty AR, Curhan G, Choi HK. Obesity, waist circumference, weight change, and the risk of psoriasis in women: nurses' health study II. Arch Intern Med 2007;167:1670–5. doi:10.1001/archinte.167.15.1670}