Do Obesity and Overweight Influence Disease Activity Measures in Axial Spondyloarthritis? A Systematic Review and Meta‐Analysis

Abstract

The aim of our systematic review and meta-analysis was to investigate whether overweight/obesity are associated with higher disease activity measures in patients with axial spondyloarthritis (SpA).Methods. MEDLINE, PubMed, and Web of Science were searched using key terms corresponding to population (axial SpA patients), exposure (overweight/obesity), and outcome (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Ankylosing Spondylitis Disease Activity Score [ASDAS]). Predefined inclusion criteria were adult patients with axial SpA, exposure classified according to body mass index (BMI), BASDAI/ASDAS reported for each BMI group, and observational studies. The Newcastle-Ottawa Scale for cohort, cross-sectional, and case-control studies was used for quality check. Random-effects meta-analysis was used to pool results, which were expressed as the mean difference (MD) in BASDAI and ASDAS between BMI groups, with 95% confidence intervals (95% CIs).Results. A total of 10 articles were included in the meta-analysis. The MD in BASDAI between normal BMI and overweight/obese patients was -0.38 (95% CI -0.56, -0.21; P < 0.0001); the MD in ASDAS between the same groups was -0.19 (95% CI -0.29, -0.09; P < 0.0001). The MD in BASDAI between normal BMI and overweight patients was -0.09 (95% CI -0.33, 0.15; P = 0.45), and the MD between normal BMI and obese patients was -0.78 (95% CI -1.07, -0.48; P < 0.0001). For ASDAS, the MD between normal BMI and overweight patients was -0.02 (95% CI -0.19, 0.15; P = 0.79), and the MD between normal BMI and obese patients was -0.42 (95% CI -0.60, -0.23; P < 0.0001).Conclusion. Overweight and obese patients with axial SpA tend to present higher disease activity scores compared to patients with a normal BMI. This difference seems to be clinically meaningful only for the comparison between obese patients and patients with normal BMI, and more for BASDAI than ASDAS.

Mediterranean diet in axial spondyloarthritis: an observational study in an Italian monocentric cohort

“…Notably, some studies in rheumatoid arthritis suggested that a slight increase in weight may also occur following MD introduction [28]. That being so, a stable BMI has not prejudiced the observed variations of disease activity in this study, which can be attributed to the diet modification [29].…”

Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs

“…Lastly, as the evidence within this review was used to formulate the taskforce’s recommendations, an update was not deemed appropriate. However, this means that some relevant papers have been published in the interim between implementing the search strategy and publishing this paper which are not included 434 435…”

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

“…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). The latter is especially problematic, given the benefits of exercise in patients with AS discussed earlier.…”