Redefining overweight and obesity in rheumatoid arthritis patients

Stavropoulos‐Kalinoglou, Antonios; Metsios, Giorgos S.; Koutedakis, Yiannis; Nevill, Alan M.; Douglas, Karen; Jamurtas, Athanasios Z.; Zanten, Jet J.C.S. Veldhuijzen van; Labib, Mourad; Kitas, George D.

doi:10.1136/ard.2006.060319

Cited by 153 publications

(123 citation statements)

References 43 publications

(53 reference statements)

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“…Potential explanations for our findings include systematic differences in the size of implants used for patients with RA and those used for patients with OA. On average, patients with RA have a lower body mass index (BMI) than patients with OA (39,40); this smaller body size may result in a tendency for surgeons to use a smaller femoral head component, which may increase the risk of dislocation Figure 2. Cumulative survival curves for the occurrence of a dislocation following total hip arthroplasty (A) and infection following total knee arthroplasty (B), both within 2 years.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Ravi

Croxford

Hollands

et al. 2014

Arthritis & Rheumatology

165

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Objective. Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are based on patients with osteoarthritis (OA); less is known about outcomes in rheumatoid arthritis (RA). Using a validated algorithm for identifying patients with RA, we undertook this study to compare the rates of complications among THA and TKA recipients between those with RA and those without RA.Methods. In patients who underwent a first primary elective THA or TKA between 2002 and 2009, those with RA were identified using a validated algorithm: a hospitalization with a diagnosis code for RA or 3 physician billing claims with a diagnosis code for RA, with at least 1 claim by a specialist (rheumatologist, orthopedic surgeon, or internist) in a 2-year period. Recipients with diagnostic codes suggesting an inflammatory arthritis, but not meeting RA criteria, were classified as having inflammatory arthritis. All remaining patients were deemed to have OA. Cox proportional hazards models, censored on death, were used to determine the relationship between the type of arthritis and the occurrence of specific complications, adjusting for potential confounders (age, sex, comorbidity, and provider volume).Results. We identified 43,997 eligible THA recipients (3% with RA) and 71,793 eligible TKA recipients (4% with RA). Total joint arthroplasty recipients with RA had higher age and sex-standardized rates of dislocation following THA (2.45%, compared with 1.21% for recipients with OA) and higher age and sex-standardized rates of infection following TKA (1.26%, compared with 0.84% for recipients with OA). Controlling for potential confounders, recipients with RA remained at increased risk of dislocation within 2 years of THA (adjusted hazard ratio [HR] 1.91, P ‫؍‬ 0.001) and remained at increased risk of infection within 2 years of TKA (adjusted HR 1.47, P ‫؍‬ 0.03) relative to recipients with OA.Conclusion. Patients with RA are at higher risk of dislocation following THA and are at higher risk of infection following TKA relative to those with OA. Further research is warranted to elucidate explanations for these findings, including the roles of medication profile, implant choice, postoperative antibiotic protocol, and method of rehabilitation following joint replacement.

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Section: Discussionmentioning

confidence: 99%

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Ravi

Croxford

Hollands

et al. 2014

Arthritis & Rheumatology

165

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“…Furthermore, obesity is becoming more and more prevalent (17). The percentage of obese RA patients has been shown to reflect the trends of the general population, thus suggesting that patients with RA should be treated accordingly, considering the risk of comorbidities associated with adiposity (18,19). Obesity was considered among the risk factors for developing RA (6,7), but more recently, a group from Leiden, The Netherlands, did not confirm the BMI values as a risk factor of evolving into RA in patients with undifferentiated arthritis (20).…”

Section: Discussionmentioning

confidence: 99%

Obesity and reduction of the response rate to anti–tumor necrosis factor α in rheumatoid arthritis: An approach to a personalized medicine

Gremese

Carletto

Padovan

et al. 2012

Arthritis Care & Research

179

134

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Objective. Obesity is a mild, long-lasting inflammatory disease and, as such, could increase the inflammatory burden of rheumatoid arthritis (RA). The study aim was to determine whether obesity represents a risk factor for a poor remission rate in RA patients requiring anti-tumor necrosis factor ␣ (anti-TNF␣) therapy for progressive and active disease despite treatment with methotrexate or other disease-modifying antirheumatic drugs.

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“…A high percentage of body fat, presenting as obesity, is a known and reversible component of CVD, the risk of which is already increased in people with RA. For a given level of body fat, the measured BMI of RA patients was significantly lower than that of controls [25]. Thus clinicians might do well to follow the suggestion of StavropoulosKalinoglou and colleagues [25] of adopting BMI cut-off points 2kg/m 2 lower than normal in order to decide when to recommend dietary and lifestyle modification in RA patients to reduce the risk of cardiovascular co-morbidity.…”

Section: Bmi and Obesitymentioning

confidence: 99%