The relationship between joint damage and functional disability in rheumatoid arthritis: a systematic review

196

158

Objective. To determine the association of obesity, defined as a body mass index (BMI) >30 or >28 kg/m 2 or by waist circumference (WC), with disease activity and severity, as well as its relationship to comorbidities in rheumatoid arthritis (RA). 9% at baseline and 15.8% at followup. In multivariable regression, BMI and obesity, defined as a BMI >30 or >28 kg/m 2 , at both inclusion and the time of the survey were independently associated with higher disease activity, fewer patients in sustained remission, higher HAQ score, more pain, and worse general health. Also, BMI and obesity independently conferred to higher odds for being diagnosed with hypertension, diabetes mellitus, and chronic pulmonary disease. Further, BMI and WC were independently associated with angina pectoris/acute myocardial infarction/coronary revascularization. In contrast, none of the examined obesity variables was associated with the prevalence of stroke or transient ischemic attack. Lifestyle changes during the observational period, such as quitting smoking or diet change, had no impact on the outcomes. Conclusion. Obesity was associated with worse RA disease outcomes and a higher prevalence of comorbidities. Body measurements are recommended to improve prediction of the disease course.

Section: Discussioncontrasting

confidence: 48%

Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: A long‐term followup from disease onset

Ajeganova

Andersson

Hafström

2012

196

158

“…We have observed the same phenomenon in individuals in our cohort, but due to the original SHS methodology, this cannot be seen in the data. Several studies have shown a strong relationship between progression of radiographic damage and functional disability at the end of the followup period (3,31,32). Radiographic damage, which already occurs early in the course of RA, accounts for a substantial proportion of the disability in established RA.…”

Section: Discussionmentioning

confidence: 99%

Sustained Beneficial Effects of a Protocolized Treat‐to‐Target Strategy in Very Early Rheumatoid Arthritis: Three‐Year Results of the Dutch Rheumatoid Arthritis Monitoring Remission Induction Cohort

Vermeer

Kuper

Moens

et al. 2013

“…Several studies in RA, predominantly involving white Eu-ropeans and some Northern Americans, have confirmed the important contribution of disease activity, duration, seropositivity, and the presence of radiographic damage (erosions) to disability (13)(14)(15)(16). In similar populations, the presence of secondary fibromyalgia averages 15% and may inflate self-reported disability (17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Correlates and predictors of disability in vulnerable US Hispanics with rheumatoid arthritis

Karpouzas¹,

Dolatabadi²,

Moran³

et al. 2012

Objective. US Hispanics with rheumatoid arthritis experience worse functional outcomes compared to whites. The determinants of disability, however, are not well established in large Hispanic cohorts. In the present report, we identified factors associated with disability in a cross-sectional design, and evaluated their individual contributions to disability over time. Methods. Two hundred fifty-one Hispanic subjects from a single center were evaluated. Disease activity, serologies, radiographs, treatments, irreversible articular damage (defined as subluxation, arthrodesis, fusion, or prosthesis), and joint replacement surgeries were recorded. Self-reported disability (Health Assessment Questionnaire disability index), patient pain by a visual analog scale, and depression assessments were collected. Cross-sectional factors associated with disability were identified, and their effects on future disability were evaluated in a subgroup of 114 patients assessed 6 months later. Results. Six parameters were independently related to disability cross-sectionally: pain was the strongest (P < 0.0001), followed by irreversible articular damage, disease activity, depression, age, and fibromyalgia (P < 0.03 for all). Baseline parameters predicting disability 6 months later included, in decreasing significance, irreversible articular damage (P ‫؍‬ 0.004), depression, disease activity, age, and pain (all P < 0.04). Conclusion. In cross-sectional analysis, self-reported pain had the strongest relationship with disability; however, factors such as irreversible articular damage, depression, and disease activity were more important in predicting future disability. Most of these factors are amenable to targeted interventions and should be addressed in an effort to improve functional outcomes.