Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Impact of Body Weight on the Progression of Radiographic Joint Damage in Rheumatoid Arthritis Patients.

Finckh4,  Axel, Scherer1,  Almut, Lubbeke-Wolff3,  Anne, Schwarz1,  Hans, Gabay2,  Cem

SCQM Foundation, Switzerland
Univ Hosp of Geneva, Geneva, Switzerland
University of Geneva, Switzerland
University of Geneva, Geneva, Switzerland

Background:

Obese individuals experience elevated levels of circulating pro-inflammatory cytokines. While obesity might be associated with an increased risk of developing RA and with impaired quality of life, the role of obesity on the progression of RA disease severity is not well established.

Objective:

To examine if obesity is associated with more radiographic joint damage progression.

Methods:

This is a prospective cohort study of the Swiss RA cohort (SCQM-RA) including all patients with available Body Mass Index (BMI) and complete sets of radiographs of the hand and feet. Patients were categorized according to the WHO BMI categories as "underweight" (BMI < 18.5), "normal weight" (BMI >= 18.5, < 25), "overweight" (BMI >= 25, < 30) and "obese" (BMI >= 30, < 35). The primary outcome of this analysis is the progression of ERO over time. Joint erosions (ERO) were assessed in 38 joints of hands and feet with a validated scoring method (Ratingen score, expressed in % of the maximum score) by a single experienced reader, blinded to clinical information. The evolution of ERO is analyzed using regression models for longitudinal data, adjusting for potential confounders.

Results:

The mean BMI of the 4852 RA patients included was 25. The groups were similar for most disease characteristics, but for baseline radiographic damage, which was significantly higher for underweight patients.

 Underweight BMI<18.5Normal weight (BMI 18.5–25)Overweight (BMI 25–30)Obese (BMI > 30)
N patients (%)219 (5%)2418 (50%)1473 (30%)742 (15%)
Age [yrs]52545858
Disease duration [yrs]6.14.33.73.4
% Female94816673
% RF+77777370
DAS28(ESR) [0–10]4.64.54.54.6
HAQ-DI [0–3]1.050.961.011.17
ERO score [% of max]106.25.85.4
Estimated ERO rate at baseline [%/yr]2.11.61.51.3
% Steroid31262429
% Biologics23202021

Patients were followed over a median duration of 4 years and assessed radiographically on average 3.3 times. After adjusting for baseline differences in prognostic markers of disease progression, underweight patients developed significantly more erosions over time then the other weight groups (p <0.001).

At 4 years, underweight patients ERO score progressed by 4.9 % (95% CI: 3.8–5.9), compared to 2.7 (CI: 2.3–3.0) in normal weight patients, 2.0 (CI: 1.6–2.4) in overweight patients and 1.8 (CI: 1.3–2.3) in obese patients.

Conclusion:

Underweight was associated with more joint damage over time, probably reflecting uncontrolled disease and 'rheumatoid cachexia'. Obesity and overweight was not associated with more rapid progression of radiographic damage in hand and feet joints.

To cite this abstract, please use the following information:
Finckh, Axel, Scherer, Almut, Lubbeke-Wolff, Anne, Schwarz, Hans, Gabay, Cem; The Impact of Body Weight on the Progression of Radiographic Joint Damage in Rheumatoid Arthritis Patients. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2257
DOI: 10.1002/art.30020

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