Body Mass Index Impact on Disease Activity, Clinical and Sonographic Remission Rates in Patients with Rheumatoid Arthritis

2019 ◽  
Vol 15 (3) ◽  
pp. 215-223
Author(s):  
Tanya Sapundzhieva ◽  
Rositsa Karalilova ◽  
Anastas Batalov
Keyword(s):  
Rheumatoid Arthritis ◽  
Body Mass Index ◽  
Disease Activity ◽  
Body Mass ◽  
Normal Weight ◽  
Clinical Disease ◽  
Clinical Disease Activity ◽  
Das 28 ◽  
Remission Rates ◽  
Activity Indices

Aim: To investigate the impact of body mass index (BMI) on clinical disease activity indices and clinical and sonographic remission rates in patients with rheumatoid arthritis (RA). Patients and Methods: Sixty-three patients with RA were categorized according to BMI score into three groups: normal (BMI<25), overweight (BMI 25-30) and obese (BMI≥30). Thirty-three of them were treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), and 30 with biologic DMARDs (bDMARDs). Patients underwent clinical and laboratory assessment and musculoskeletal ultrasound examination (MSUS) at baseline and at 6 months after initiation of therapy. We evaluated the rate of clinical and sonographic remission (defined as Power Doppler score (PD) = 0) and its correlation with BMI score. Results: In the csDMARDs group, 60% of the normal weight patients reached DAS28 remission; 33.3% of the overweight; and 0% of the obese patients. In the bDMARDs group, the percentage of remission was as follows: 60% in the normal weight subgroup, 33.3% in the overweight; and 15.8% in the obese. Within the csDMARDs treatment group, two significant correlations were found: BMI score–DAS 28 at 6th month, rs = .372, p = .033; BMI score–DAS 28 categories, rs = .447, p = .014. Within the bDMARDs group, three significant correlations were identified: BMI score–PDUS at sixth month, rs = .506, p =.004; BMI score–DAS 28, rs = .511, p = .004; BMI score–DAS 28 categories, rs = .592, p = .001. Sonographic remission rates at 6 months were significantly higher in the normal BMI category in both treatment groups. Conclusion: BMI influences the treatment response, clinical disease activity indices and the rates of clinical and sonographic remission in patients with RA. Obesity and overweight are associated with lower remission rates regardless of the type of treatment.

The correlation between ultrasound-detected synovitis of small joints and the clinical disease activity in patients with rheumatoid arthritis

2020 ◽  
Author(s):  
Xuerong Deng ◽  
Xiaoying Sun ◽  
Wenhui Xie ◽  
Yu Wang ◽  
Zhuoli Zhang
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Activity Index ◽  
Power Doppler ◽  
Disease Activity Index ◽  
Clinical Disease ◽  
Joint Involvement ◽  
Clinical Disease Activity ◽  
Hands And Feet ◽  
Activity Indices

Abstract Background: Rheumatoid arthritis (RA) is chronic inflammatory arthritis with multi-joint involvement, especially small synovial joints in hands and feet. So far, the synovitis of which joint in hands or feet is better correlated with clinical disease activity indices is unknown; the correlation of synovitis detected by ultrasound in an individual joint with global disease activity is unclear either.Objectives: To explore the correlation between the ultrasound-detected synovitis in metacarpophalangeal (MCP), metatarsophalangeal (MTP), proximal interphalangeal (PIP) joints and the clinical disease activity indices in patients with RA.Methods: 30 joints, including bilateral MCP, PIP and MTP, were scanned for synovitis by ultrasound, semi-quantitatively scored for gray scale(GS) and power Doppler(PD). The correlation between Disease Activity Score-28 joints(DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and ultrasound-detected synovitis score in each joint was assessed using Spearman’s rank correlation test. Results: 211 RA patients were included in this study. The whole GS scores of all MCP joints showed highest correlation with all clinical disease activity indices (r=0.403-0.452, p<0.01), followed by PIPs (r=0.318-0.331, p<0.01) and MTPs (r=0.277-0.301, p<0.01). Likewise, the whole PD scores of all MCP joints also showed highest correlation with the disease activity (r=0.332-0.396, p<0.01), followed by PIPs (r=0.211-0.242, p<0.01), and MTPs (r=0.198-0.222, p<0.01). The highest correlation of GS score with DAS28-ESR (r=0.411, p<0.01), DAS28-CRP (r=0.459, p<0.01), SDAI (r=0.444, p<0.01) was observed in MCP3 joint, while with CDAI (r=0.421, p<0.01) in MCP2 joint. The highest correlation of PD score with DAS28-ESR (r=0.353, p<0.01), DAS28-CRP (r=0.399, p<0.01), CDAI (r=0.368, p<0.01), SDAI (r=0.377, p<0.01) was in MCP5 joint. Conclusions: The ultrasound-detected synovitis at MCP joints, especially MCP2, MCP3, and MCP5 joints, was best correlated with composite disease activity of RA, in contrast to PIP and MTP joints. MCP joints should take greater weight in clinical disease activity assessment.

scholarly journals OP0220 ASSESSING THE EFFECT OF INCREASED BODY MASS INDEX ON RESPONSE TO TNF INHIBITORS IN ESTABLISHED RHEUMATOID ARTHRITIS: RESULTS FROM THE METEOR DATABASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 137.1-137
Author(s):  
M. Dey ◽  
S. S. Zhao ◽  
R. J. Moots ◽  
R. B. M. Landewé ◽  
N. Goodson
Keyword(s):  
Rheumatoid Arthritis ◽  
Body Mass Index ◽  
Body Mass ◽  
Personalised Medicine ◽  
Normal Weight ◽  
Sensitivity Analyses ◽  
Established Rheumatoid Arthritis ◽  
Eular Response ◽  
Significant Difference ◽  
Das28 Remission

Background:Rheumatoid arthritis (RA) is associated with increased body mass index (BMI)- 60% of patients are either overweight or obese. Obesity in RA has been shown to predict reduced response to biologic therapy including tumour-necrosis-factor inhibitors (TNFi) [1]. However, it is not clear whether increased BMI influences response to all TNFi drugs in RA.Objectives:1.To explore whether BMI is associated with response to TNFi in patients with established rheumatoid arthritis (estRA), including those newly-starting on these drugs.Methods:Participants with estRA (>1year since diagnosis) taking biologic medications, registered on METEOR (international database of RA patients), 2008-2013, were included. EULAR response, DAS28 remission (including components), and treatment regimens were recorded at baseline, 6, and 12 months. WHO definitions of overweight (BMI≥ 25) and obese (BMI≥30) were explored as predictors of TNFi response (good EULAR response and DAS28 remission) using normal BMI as comparator. Logistic and linear regression models (controlling for age, gender, smoking, and baseline outcomes) and sensitivity analyses were performed. Subgroup analyses were performed for grouped TNFi and individual TNFi (infliximab, IFX; adalimumab, ADA; etanercept, ETN).Results:247 patients with estRA were taking a biologic at 6 months, and 231 patients were taking a biologic at 12 months. Obese patients taking any biologic were significantly less likely to achieve DAS28 remission (OR 0.33 [95%CI 0.12-0.80]) or good EULAR response (OR 0.37 [95%CI 0.16-0.81]) after 6 months, compared to those of normal BMI; this was also demonstrated in those co-prescribed methotrexate (DAS28 remission: OR 0.23 [95%CI 0.07-0.62]; good EULAR response: OR 0.39 [95%CI 0.15-0.92]). These associations did not remain statistically significant at the 12 months assessment.Regarding specific anti-TNF therapies, RA patients treated with monoclonal antibody (-mab) TNFis (IFX/ADA/ GOL) were significantly less likely to achieve good EULAR response at 6 months if they were obese RA (n=38), compared to those of normal weight (n=44) (OR 0.17 [95%CI 0.03-0.59]). A similar non-significant difference was demonstrated for DAS28 remission, and 12-month remission. Specifically, obese individuals were significantly less likely to achieve good EULAR response at 6 months with IFX (OR 0.09 [95%CI 0.00-0.61]; n=20), and significantly less likely to achieve DAS28 remission at 6 months when newly-starting ADA (OR 0.14 [95%CI 0.01-0.96]; n=17), compared to those of normal weight. There were no significant differences in remission outcomes between individuals of different BMI taking ETN. A small number of individuals stopped taking their respective biologic after 6months; reason for cessation was not recorded.Similar outcomes were seen in patients already established on anti-TNF therapy, with overweight and obese individuals less likely overall to be in DAS28 remission at all time points.Conclusion:In established RA, obesity is associated with reduced treatment response to -mab TNFi. No association between increased BMI and response to ETA was observed. Using BMI to direct biologic drug choice could prove to be a simple and cost-effective personalised-medicine approach to prescribing.References:[1]Schäfer M, Meißner Y, Kekow J, Berger S, Remstedt S, Manger B, et al. Obesity reduces the real-world effectiveness of cytokine-targeted but not cell-targeted disease-modifying agents in rheumatoid arthritis. Rheumatology. 2019 Nov 20.Disclosure of Interests:Mrinalini Dey: None declared, Sizheng Steven Zhao: None declared, Robert J Moots: None declared, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Nicola Goodson: None declared

Sign in / Sign up

Export Citation Format

Share Document