In RA, Normal Weight May Be the Patient’s Best Friend
In a study of 944 patients diagnosed with rheumatoid arthritis (RA) within the last 12 months, investigators found that both those who were either significantly underweight or overweight/obese were less likely to achieve sustained remission than patients with normal body mass index (BMI).
“Having an elevated BMI is clearly linked to worse outcomes,” said lead author Dr. Susan Goodman, a rheumatologist at the Hospital for Special Surgery in New York, where the study took place. She pointed out that individuals in the highest BMI categories also had more inflammation and more pain. “Patients who were severely obese had an even lower chance of achieving sustained remission,” she said.
“I’d put this in the same category as the importance of other choices patients make that can modify their outcomes,” she said.
These findings were presented in November 2014 at the annual meeting of the American College of Rheumatology.
Specifically, the study was designed to determine whether patients in the early stages of RA with BMI less than 18.5 (i.e., very low) or 25 (very high) were able to achieve sustained remission. BMI is a measure of body fat based on height and weight. (Note that BMI below 18.5 is considered underweight; BMI from 24.9 – 29.9 is considered overweight; BMI over 30 is considered obese.)
Patients were selected from the Canadian Early Arthritis Cohort study (CATCH), a multi-center research program involving 1,800 people at 19 clinical sites. The mission of CATCH is to educate people on the benefits of early arthritis treatment.
Measuring disease. Symptoms were measured over three years using the Disease Activity Score for Rheumatoid Arthritis (DAS28). This is a common outcome measure which takes into consideration a variety of signs and symptoms, including the number of swollen and tender joints, inflammation markers in the blood, and even the patients’ assessments of their disease. It is widely used to determine the severity of any individual’s RA, and indicates whether or not a patient is in remission.
For this study, sustained remission was defined as having low disease activity at two consecutive doctor visits three to six months apart.
Along with the aforementioned findings, the study demonstrated that smokers were also less likely to achieve sustained remission, according to Dr. Vivian Bykerk, the study’s principal investigator and director of the Inflammatory Arthritis Center at the hospital.
The study concluded that early use of methotrexate, early response to treatment, and non-smoking status improved the odds of sustained remission, independent of BMI. It also recommended that BMI be considered among the modifiable risk factors for poor outcomes in rheumatoid arthritis.
Oddly, patients with a very low BMI also had more inflammation, but they were too few in number to be considered of statistical significance.
The study found that obesity and being overweight could both decrease the likelihood of achieving a sustained remission. “I think it really stresses the point that there are a lot of environmental factors that contribute to outcome,” says Dr. Goodman.
“That was a very small group, and given the size of that group, it’s very hard for us to know if that was just patients who were underweight because they were so ill. There were more smokers among that group; there were a lot of things that it’s very hard to generalize from,” said Dr. Goodman.
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