Impact of body weight on the achievement of minimal disease activity in patients with rheumatic diseases: a systematic review and meta-analysis

Abstract

BackgroundIn this study, we evaluated the impact of obesity and/or overweight on the achievement of minimal disease activity (MDA) in patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA) receiving an anti-rheumatic treatment. Obesity can be considered a low-grade, chronic systemic inflammatory disease and some studies suggested that obese patients with rheumatic diseases exhibit a lower rate of low disease activity achievement during treatment with anti-rheumatic drugs.MethodsA systematic search was performed in major electronic databases (PubMed, Web of Science, Scopus, Embase) to identify studies reporting MDA achievement in obese and/or overweight patients with RA or PsA and in normal-weight RA or PsA control subjects. Results were expressed as Odds Ratios (ORs) with pertinent 95% Confidence Intervals (95%CIs).ResultsWe included 17 studies (10 on RA and 7 on PsA) comprising a total of 6693 patients (1562 with PsA and 5131 with RA) in the analysis. The MDA achievement rate was significantly lower in obese patients than in normal-weight subjects (OR 0.447, 95% CI 0.346–0.577, p < 0.001, I 2 = 62.6%, p < 0.001). Similarly, overweight patients showed a significantly lower prevalence of MDA achievement than normal-weight subjects (OR 0.867, 95% CI 0.757–0.994, p = 0.041, I 2 = 64%, p = 0.007). Interestingly, the effect of obesity on MDA was confirmed when we separately analyzed data on patients with RA and patients with PsA. In contrast, when we evaluated the effect of overweight, our results were confirmed for PsA but not for RA. A meta-regression analysis showed that follow-up duration, age, male sex, and treatment duration are covariates significantly affecting the effect of obesity/overweight on MDA achievement.ConclusionsThe results of our meta-analysis suggest that obesity and overweight reduce the chances to achieve MDA in patients with rheumatic diseases receiving treatment with traditional or biologic disease-modifying antirheumatic drugs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-016-1194-8) contains supplementary material, which is available to authorized users.

The Impact of Comorbidity on Patient-Reported Outcomes in Psoriatic Arthritis: A Systematic Literature Review

“…In summary, there is sufficient evidence demonstrating the high prevalence of comorbidity [2,4,5] in patients with PsA and its impact on outcome measures, treatment response and clinical decision-making [6,[9][10][11][12][13]. A number of studies have also highlighted that comorbidity clearly impairs function and quality of life in PsA patients.…”

“…It has also been reported that the presence of comorbidities may influence the treatment response and decisionmaking process. Different studies have shown that both obesity and metabolic syndrome are associated with lower retention rates of and response rates to biological therapy [10][11][12], and a systematic literature review found that obesity and overweight reduce the odds to achieve minimal disease activity in patients with PsA receiving treatment with traditional or biologic drugs [13].…”

Association of weight loss with improved disease activity in patients with rheumatoid arthritis: A retrospective analysis using electronic medical record data

“…In another meta-analysis of four previous studies, RA patients who were obese were 47% less likely to be in remission/low disease activity by DAS28 (OR 0.53, 95% CI 0.41, 0.69) (32). Most recently, in a meta-analysis of 10 prior studies, patients with obesity were 42% less likely to achieve minimal disease activity compared to patients with normal BMI (OR 0.58, 95% CI 0.40–0.85) (33). In a study performed in the Netherlands, continuous BMI was positively correlated with DAS28 ( r =0.34, p =0.001) (34).…”

Impact of Comorbidity on Physical Function in Patients With Ankylosing Spondylitis and Psoriatic Arthritis Attending Rheumatology Clinics: Results From a Cross‐Sectional Study

“…Obesity negatively influences not only CVD risk but also other disease outcomes. In this regard, being obese and overweight reduces the chances to achieve minimal disease activity in patients with PsA receiving traditional or biologic DMARD therapy .…”