Association of obesity with inflammation, disease severity and cardiovascular risk factors among patients with ankylosing spondylitis

Abstract

Aim To investigate total and central obesity in ankylosing spondylitis (AS), and assess the association with inflammation, disease severity and cardiovascular risk factors. Methods There were 105 AS patients enrolled. Anthropometry was measured to determine total (body mass index [BMI]) and central obesity (waist circumference [WC], waist‐to‐height ratio [WHtR]). We evaluated patients’ disease activity, functional ability, global assessment, physical mobility, radiographic damage and health index. Erythrocyte sedimentation rate, C‐reactive protein (CRP) and blood biochemistry profile were tested. Retrospective radiographic change was assessed in 39 patients. Presence of diabetes and hypertension were examined. Results The obese AS patients had higher inflammation (CRP), disease activity (Ankylosing Spondylitis Disease Activity Score [ASDAS] ‐ CRP), physical mobility (Bath Ankylosing Spondylitis Metrology Index [BASMI]), radiographic damage (modified Stoke Ankylosing Spondylitis Spinal Score [m‐SASSS]), liver function and blood pressure (all P < .05). Obesity (BMI, WC, WHtR) positively correlated with inflammation (CRP), physical mobility (BASMI), radiographic damage (m‐SASSS), health index (Assessment of SpondyloArthritis International Society Health Index), liver function and blood pressure (all P < .05). Moreover, presence of central obesity (WC, WHtR) had correlation with disease activity (ASDAS‐CRP) (r = .218, P = .027; r = .221, P = .025), and predicted longitudinal radiographic change (m‐SASSS) (standard coefficient = 0.300, P = .041; standard coefficient = 0.288, P = .045). Importantly, central obesity was better in predicting high inflammation, disease activity, physical mobility, radiographic damage and health index in AS, and WHtR was the best for predicting m‐SASSS (area under the curve = 0.734, P < .001). Obesity was associated with increased risk of diabetes and hypertension in AS. Conclusion Obesity was associated with higher inflammation, disease activity, physical mobility, radiographic damage, health index, liver function and cardiovascular risk factors in AS. Central obesity could predict a patient's longitudinal radiographic change. Central obesity is a useful predictor for high disease severity in AS.

The Effect of Ketogenic Diet on Inflammatory Arthritis and Cardiovascular Health in Rheumatic Conditions: A Mini Review

“…Extensive experimental and clinical research suggests that being overweight or obese impacts not only disease activity but also several aspects of the life of patients living with inflammatory arthritis ( 109 ). Weight loss improves outcomes in patients with RA ( 37 , 38 , 44 , 49 ), PsA ( 39 , 61 , 64 ) and AS ( 110 , 111 ). Besides inflammatory arthritis, metabolic, and eating disorders were suggested to facilitate the occurrence of early clues of connective tissue disorders ( 112 ) and obesity was shown to worsen musculoskeletal symptoms also in patients with fibromyalgia ( 113 ).…”

Lifestyle modification and inflammation in people with axial spondyloarthropathy—A scoping review

“…Obesity is approximately seven percent more common in patients with AS than the general population (Maas et al., 2016) and this is associated with higher BASDAI, greater CRP concentrations, spinal stiffness, worse physical function, and worse quality of life than normal weight patients (Bindesbøll et al., 2020; Chen et al., 2020; Maas et al., 2015). Additionally, visceral fat has been found to be positively associated with BASDAI and pain, body fat percentage with BASDAI (Aydin et al., 2014), and central obesity with BASDAI and radiographic change (Chen et al., 2020).…”

“…Obesity is approximately seven percent more common in patients with AS than the general population (Maas et al., 2016) and this is associated with higher BASDAI, greater CRP concentrations, spinal stiffness, worse physical function, and worse quality of life than normal weight patients (Bindesbøll et al., 2020; Chen et al., 2020; Maas et al., 2015). Additionally, visceral fat has been found to be positively associated with BASDAI and pain, body fat percentage with BASDAI (Aydin et al., 2014), and central obesity with BASDAI and radiographic change (Chen et al., 2020). Body mass index (BMI) is positively associated with BASDAI (Lee et al., 2019; Liew et al., 2020; Ortolan et al., 2020), inadequate response to TNFi treatment (Shan & Zhang, 2019; Singh et al., 2018), new syndesmophyte formation, and Modified Stoke ankylosing spondylitis spine score (mSASSS) progression (Bakirci et al., 2020), worse perceptions regarding the benefits of exercise, and enhanced awareness of barriers to exercise (Durcan et al., 2012).…”

Association of blood pressure and hypertension with radiographic damage among the patients with ankyloing spondylitis

“…Chronic inflammation in AS patients can cause syndesmophyte formation and lead to spinal ankylosis, resulting in limitation of spinal mobility. [ 2 ]…”