Modifiable Lifestyle Factors Associated With Response to Treatment in Early Rheumatoid Arthritis

Abstract

Objective We aimed to evaluate the associations between response to algorithm‐directed treat‐to‐target conventional synthetic disease‐modifying antirheumatic drug therapy and potentially modifiable lifestyle factors, including dietary fish oil supplementation, body mass index (BMI), and smoking history in a rheumatoid arthritis (RA) inception cohort. Methods Patients with RA with a duration of less than 12 months were reviewed every 3 to 6 weeks to adjust therapy according to disease response. All patients received advice to take fish oil supplements, and omega‐3 status was measured as plasma levels of eicosapentaenoic acid (EPA). Lifestyle factors and other variables potentially prognostic for 28‐joint Disease Activity Score (DAS28) remission and DAS28 low disease activity (LDA) at the 12‐month visit were included in multivariable logistic regression models. Results Of 300 participants, 57.7% reached DAS28 LDA, and 43.7% were in DAS28 remission at 1 year. Increase in plasma EPA was associated with an increase in the odds of being in LDA (adjusted odds ratio [OR] = 1.27; P < 0.0001) and remission (adjusted OR = 1.21; P < 0.001). There was some evidence that the effect of BMI on LDA might be modified by smoking history. An increase in BMI was associated with a decrease in the odds of being in LDA in current and former smokers but had no impact on LDA in patients who had never smoked. There were no meaningful associations between BMI or smoking history and remission. Conclusion Omega‐3 status, BMI, and smoking history are potential predictors of outcome in early RA. The possibility of an effect modification by smoking on the predictive value of BMI merits further investigation.

2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis

“…Lifestyle advice based on evidence should be given to better manage common comorbidity and patients should be guided and encouraged by their healthcare team to adopt healthy behaviours A number of modifiable lifestyle factors in IA can affect outcome. 52 For example, the negative effects of smoking 53 as well as high body mass index 54 impact on inflammation and disease activity are now well established, as is the increased risk of cardiovascular disease. 55 Lifestyle approaches should complement medical treatments, as also supported by a EULAR taskforce dedicated to providing recommendations on specific lifestyle interventions for the management of RMDs (currently ongoing).…”

What is the best target in a treat-to-target strategy in rheumatoid arthritis? Results from a systematic review and meta-regression analysis

“…Of the 3879 articles identified through the literature search, 66 articles were selected after title, abstract, full-text and reference screening (figure 1). 27–92 Characteristics of selected articles including RoB assessments are shown in online supplemental table S1. These 66 selected articles concerned results from 40 studies, and from these the data of 169 treatment arms were extracted.…”

Obesity and Response to Advanced Therapies in Rheumatoid Arthritis

“…One of the key findings from the current analysis that advances the literature is lack of effect modification for TNFi and non-TNFi therapies across BMI categories. A number of prior studies and meta-analyses have suggested poor response to TNFi among patients who are obese (6,7,14). While we are not aware of head-to-head comparative effectiveness studies in this area, 1 study by Schafer et al (15) compared the association between obesity and clinical response across RA therapies in a large observational cohort study (Rheumatoid Arthritis: Observation of Biologic Therapy [RABBIT]).…”

“…A number of studies have evaluated whether obesity, one of the most common comorbid conditions in patients with arthritis, might influence the response to biologic therapies for RA as summarized in recent reviews, pooled analyses, and meta-analyses (1)(2)(3)(4)(5). These studies have suggested lower rates of clinical response among obese patients with RA (6,7), although they also demonstrate a high rate of heterogeneity and some evidence of publication bias (1). The evidence to date has, therefore, not allowed the rheumatology community to reach a consensus regarding whether obesity is associated with a refractory disease phenotype nor how the presence of obesity should modify the choice of RA therapy.…”