Inflammation, obesity and rheumatic disease: common mechanistic links. A narrative review

Abstract

Obesity represents a rising global health concern, linked to significant social, psychological and physical burden to the individual affected, people around them and the society as a whole. Obesity has been described as a low-grade inflammatory condition, associated with increased production of pro-inflammatory mediators like tumor necrosis factor alpha or interleukin 6 and altered expression of adipokines. Adipokines, mainly produced by adipose tissue, have mixed pro- and anti-inflammatory properties. Obesity rarely exists on its own; instead, it tends to coexist with (often multiple) other comorbidities, including metabolic, cardiovascular, and rheumatic and musculoskeletal diseases (RMDs). In the case of RMDs, evidence is rapidly accumulating on common mechanistic pathways implicated in the inflammatory states seen between RMDs and obesity. Although there remain unanswered questions on the exact mechanisms of inflammation that link obesity to RMDs, what is becoming increasingly known is the association between obesity and adverse clinical outcomes in RMDs. This narrative review discusses insights into mechanisms of inflammation linking obesity and RMDs and evidence on the impact of obesity on treatment response and important disease outcomes. We highlight the importance of targeting obesity, a common and modifiable comorbidity, as part of the routine care of people with RMDs.

Increased plasmatic NETs by-products in patients in severe obesity

“…Obesity increases cardiovascular risk even in the absence of other risk factors such as diabetes, dyslipidaemia, hypertension 7 as well as rheumatic diseases 8 . Currently the extent of the generation of NETs and their role in experimental models of obesity and in obese patients is controversial 9–11 .…”

Alterações da resposta imune em pacientes com obesidade

“…Também modulam ativamente a resposta inflamatória aguda e crônica, desempenhando importante papel na autoimunidade, inflamação, obesidade além do remodelamento e catabolismo ósseo e cartilaginoso. Assim, alterações funcionais podem levar ao desenvolvimento de osteoartrite, artrite reumatóide, artrite psoriásica e outras doenças imunológicas (FERNÁNDEZ CR, et al, 2019;NIKIPHOROU E e FRAGOULIS GE, 2018).…”

Atherosclerosis in Rheumatology: Old and New Insights

“…Obesity, as well as MetS, is a global health problem especially in developed countries. The prevalence has been constantly growing over the years and to date, it is estimated to be almost 40% in the general population [21,22]. Nevertheless, the association of obesity and CVDs in the general population is not clear [23].…”

“…However, there is a well-known correlation of obesity and increased risk of T2DM and coronary arterial disease (CAD), as well as a negative impact of obesity on other comorbidities including rheumatic diseases [23]. The immunomodulatory potential of adipose tissue and its ability to create an inflammatory environment of moderate activity could explain the effect of obesity as a risk factor for the development of some autoimmune diseases [22,25].…”

“…Thus, obesity is not only a passive comorbidity, but can actively participate in the inflammatory process. According to the current evidence, obesity can negatively affect the course of most rheumatic diseases, functional disability, quality of life and the overall prognosis [21,22].…”