Association of High Body Mass Index With Decreased Treatment Response to Combination Therapy in Recent‐Onset Rheumatoid Arthritis Patients

Abstract

Objective. To assess the association between high body mass index (BMI) and treatment response in recent-onset rheumatoid arthritis. Methods. In the Behandelstrategieën voor Reumatoide Artritis (Treatment Strategies for Rheumatoid Arthritis) study, 508 patients were randomized to initial monotherapy or combination therapy with prednisone or infliximab (IFX). The response to Disease Activity Score (DAS) <2.4 -steered treatment (first dose and after 1 year) was compared between patients with a BMI <25 kg/m 2 and >25 kg/m 2 , using relative risk (RR) regression analyses. DAS, components of DAS, and functional ability during the first year were compared using linear mixed models. Results. High BMI was independently associated with failure to achieve a DAS <2.4 on initial therapy (RR 1.20 [95% confidence interval (95% CI) 1.05, 1.37]). The effect for combination therapy with prednisone was RR 1.55 (95% CI 1.06, 2.28) and for combination therapy with IFX 1.42 (95% CI 0.98, 2.06). The RRs for failure after 1 year were 1.46 (95% CI 0.75, 2.83) and 2.20 (95% CI 0.99, 4.92), respectively. High BMI was also associated with failure on delayed combination therapy with IFX, after adjustment for selection bias related to previous failure on disease-modifying antirheumatic drugs. No significant association was observed in the initial monotherapy groups. In the first year, patients with a high BMI had higher DAS and worse functional ability, with more tender joints and a higher visual analog scale global health, but not more swollen joints and similar systemic inflammation. Conclusion. High BMI was independently associated with failure to achieve low DAS on initial combination therapy with prednisone and on initial and delayed treatment with IFX. Patients with a high BMI experienced more pain, but not more swelling or systemic inflammation.

Prevalence of obesity in rheumatoid arthritis and its association with disease activity and latex positivity in a sample of patients in Erbil

“…32 Furthermore, 1596 obese patients with early RA were monitored for a mean 9.5±3.7 years, when compared with patients with normal weight, it turn out that obesity early and during follow up was strongly related to higher disease activity (mean DAS28 3.0±1.2 vs. 2.7±1.3, P = 0.002), less sustained remission rate (20.5% vs 26.6%; p=0.048) and increase in the mean pain level (32.9±23.9 vs 25.8±23.8; p=0.005). 33,34 The rise in DAS28 observed in these studies appeared to be subjectively influenced ( number of sore joints as well as patients overall assessment [34][35][36] ) and not linked to C reactive protein level or ESR. 36,37 In two studies, Health Questionnaire Assessment (HAQ) was recruited to assess functional disability in RA patients.…”

“…33,34 The rise in DAS28 observed in these studies appeared to be subjectively influenced ( number of sore joints as well as patients overall assessment [34][35][36] ) and not linked to C reactive protein level or ESR. 36,37 In two studies, Health Questionnaire Assessment (HAQ) was recruited to assess functional disability in RA patients. The score was significantly higher in obese patients than in normal weight patients (0.6±0.7 vs. 0.5±0.6; P <0.001, and +0.16 (95% CI 0.03 to 0.30) respectively).…”

Body Mass Index and response to rituximab in rheumatoid arthritis

“…Recent reports showed a negative association between BMI and response to anti-TNF␣ therapies, notably infliximab (IFX), in RA [13][14][15], psoriatic arthritis [16,17] and ankylosing spondylitis (AS) [18,19], which suggests that fat mass may affect the response to biologic agents. BMI might be a predictive factor of IFX response in RA, but no study has evaluated the impact of BMI on rituximab (RTX) response in RA.…”

Adipokine Mediators of Inflammation and Cardiometabolic Comorbidity in Rheumatoid Arthritis: Is There a Master Adipokine?

“…For example, several high-quality studies have demonstrated that RA patients with a higher body mass index (BMI, a surrogate for adiposity), have lower all-cause and CVD mortality 13 , and tend to be protected from erosive damage 14 . This protection is found to exist despite the observation that RA patients with higher BMI tend to have higher measures of disease activity than those with lower BMI, and a diminished treatment response to some biologic disease-modifying antirheumatic drugs 15 . Clearly, the relationships that link the inflammatory products of adipose tissue with RA-associated outcomes are complex, dynamic, possibly conditioned on other patient-specific features, and not easily explained using simple correlations and bivariate modeling techniques.…”