AB0408 Increase of body mass index in a tight controlled methotrexate-based strategy with prednisone in early rheumatoid arthritis (CAMERA-II): Is it a side-effect of the prednisone or better control of disease activity?

Abstract

Background In the Computer Assisted Management of Early RA trial-II (CAMERA-II),patients aged ≥18 years with early RA (disease duration <1 year and no prior use of DMARDs) were included and randomized to an MTX-based tight control strategy with either 10 mg of Prednisone (MTX+pred) or placebo (MTX+plac)[1]. The MTX+predgroup had lower disease activity, disability and less erosive joint damage, compared to the MTX+plac group, but gained significantly more in weight than the MTX+plac group: mean 2.9 kg (standard deviation, SD 4.2) versus 1.3 kg (SD 5.3), p=0.03. Objectives To examine the association of glucocorticoids and disease activity with subsequent changes in body mass index (BMI). Furthermore the effect of BMI on disease activity was investigated. Methods Data from 224 patients of the CAMERA-II trial with monthly measurements of disease activity (DAS28) and BMI were used. Longitudinal regression (mixed model) analysis with BMI as dependent variable and DAS28 and treatment strategy as independent variables correcting for possible confounders (age, gender, rheumatoid factor, baseline BMI) was used. Separately, a longitudinal regression analysis with DAS28 as dependent variable and BMI and treatment strategy as independent variables, correcting for possible confounders was performed. To study the associations between disease activity and BMI several time lags between these variables were tested and the best fitting model was selected. To further focus on the longitudinal associations within patients an autoregressive model was used. Results There was no independent association of glucocorticoid therapy with changes in BMI. A decrease in DAS28 resulted in an increase in BMI 6 months later; also a rise in BMI was associated with a rise in DAS28 6 months later. Conclusions The higher BMI in the MTX+pred group seems (at least partly) attributable to a reduction of disease activity. A rise in BMI is associated with a rise in disease activity. References Bakker MF, Jacobs JWG, et al. Low-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid Arthritis. A Randomized Trial. Ann Intern Med 2012; 156: 329-39 Disclosure of Interest None Declared