Weight Loss, the Obesity Paradox, and the Risk of Death in Rheumatoid Arthritis

Baker, Joshua F.; Billig, Erica; Michaud, Kaleb; Ibrahim, Said A.; Caplan, Liron; Cannon, Grant W.; Stokes, Andrew; Majithia, Vikas; Mikuls, Ted R.

doi:10.1002/art.39136

Cited by 90 publications

(82 citation statements)

References 32 publications

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“…We used the WHO classification of BMI categories for underweight (<18.5 kg/m 2 ), normal weight (18.5 to <25.0 kg/m 2 ), overweight (25.0 to <30 kg/m 2 ), and obese (≥30.0 kg/m 2 ) (20). As previously described, we used the mode of the height of all measures when calculating BMI since patients may have had slightly different heights recorded at different visits (21). Since weight loss would typically only be recommended for those who were overweight or obese, we included the BMI category at baseline in our analysis.…”

Section: Methodsmentioning

confidence: 99%

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

Kreps¹,

Halperin²,

Desai³

et al. 2018

ISSN 1758-4272 Int. J. Clin. Rheumatol

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Objective To evaluate the association between weight loss and rheumatoid arthritis (RA) disease activity. Methods We conducted a retrospective cohort study of RA patients seen at routine clinic visits at an academic medical center, 2012–2015. We included patients who had ≥2 clinical disease activity index (CDAI) measures. We identified visits during follow-up where the maximum and minimum weights occurred and defined weight change and CDAI change as the differences of these measures at these visits. We defined disease activity improvement as CDAI decrease of ≥5 and clinically relevant weight loss as ≥5 kg. We performed logistic regression analyses to establish the association between improved disease activity and weight loss and baseline BMI category (≥25 kg/m2 or <25 kg/m2). We built linear regression models to investigate the association between continuous weight loss and CDAI change among patients who were overweight/obese at baseline and who lost weight during follow-up. Results We analyzed data from 174 RA patients with a median follow-up of 1.9 years (IQR 1.3–2.4); 117 (67%) were overweight/obese at baseline, and 53 (31%) lost ≥5 kg during follow-up. Patients who were overweight/obese and lost ≥5 kg had three-fold increased odds of disease activity improvement compared to those who did not (OR 3.03, 95%CI 1.18–7.83). Among those who were overweight/obese at baseline, each kilogram weight loss was associated with CDAI improvement of 1.15 (95%CI 0.42–1.88). Our study was limited by using clinical data from a single center without fixed intervals for assessments. Conclusion Clinically relevant weight loss (≥5 kg) was associated with improved RA disease activity in the routine clinical setting. Further studies are needed for replication and to evaluate the effect of prospective weight loss interventions on RA disease activity.

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Section: Methodsmentioning

confidence: 99%

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

Kreps¹,

Halperin²,

Desai³

et al. 2018

ISSN 1758-4272 Int. J. Clin. Rheumatol

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“…Although obesity is a recognized cardiovascular risk factor, an “obesity paradox” has been observed in rheumatoid arthritis whereby greater body mass is protective of cardiovascular disease mortality 85. Proposed hypotheses include the inadequacy of commonly used body composition measures, epidemiologic phenomena such as index event bias,86 confounding by comorbidity,85 and lack of consideration of weight trajectories 8788. Adiposity itself may contribute to systemic inflammation, insulin resistance, and cardiovascular disease risk through the release of adipokines or other pro-inflammatory mediators 8990919293…”

Section: Mechanisms Linking Rheumatoid Arthritis and Cardiovascular Dmentioning

confidence: 99%

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

England

Thiele

Anderson

et al. 2018

BMJ

378

266

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Rheumatoid arthritis is a systemic autoimmune disease characterized by excess morbidity and mortality from cardiovascular disease. Mechanisms linking rheumatoid arthritis and cardiovascular disease include shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, alterations in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction. Despite a growing understanding of these mechanisms and their complex interplay with conventional cardiovascular risk factors, optimal approaches of risk stratification, prevention, and treatment in the context of rheumatoid arthritis remain unknown. A multifaceted approach to reduce the burden posed by cardiovascular disease requires optimal management of traditional risk factors in addition to those intrinsic to rheumatoid arthritis such as increased disease activity. Treatments for rheumatoid arthritis seem to exert differential effects on cardiovascular risk as well as the mechanisms linking these conditions. More research is needed to establish whether preferential rheumatoid arthritis therapies exist in terms of prevention of cardiovascular disease. Ultimately, understanding the unique mechanisms for cardiovascular disease in rheumatoid arthritis will aid in risk stratification and the identification of novel targets for meaningful reduction of cardiovascular risk in this patient population.

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“…In a recent study, weight loss, especially rapid weight loss over 1 year, was a strong predictor of death in patients with RA [72•]. The strong association between weight loss and mortality may obscure the association between obesity and mortality in epidemiologic studies.…”

Section: Obesity and Long-term Outcomes In Ramentioning

confidence: 99%

The Obesity Epidemic and Consequences for Rheumatoid Arthritis Care

George

Baker

2016

Curr Rheumatol Rep

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With the prevalence of obesity increasing dramatically worldwide over the past several decades, an increasing body of literature has examined the impact of obesity in the context of rheumatoid arthritis (RA). Epidemiologic studies suggest that obesity may be associated with a modestly increased risk for the development of RA, although these studies have shown conflicting results. Among patients with established RA, obesity has been observed to be associated with greater subjective measures of disease activity and poor treatment response, but also with a decreased risk of joint damage and lower mortality. A comprehensive evaluation of the influence of obesity on the measurement of disease, response to therapies, and long-term prognosis is critical in order to understand these observations. This review therefore focuses on recent observations, potential explanations for these findings, and implications for clinicians and investigators caring for and studying patients with RA.

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Weight Loss, the Obesity Paradox, and the Risk of Death in Rheumatoid Arthritis

Cited by 90 publications

References 32 publications

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

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

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

The Obesity Epidemic and Consequences for Rheumatoid Arthritis Care

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