RA remission much less likely in overweight, obese patients

John Murphy, MDLinx | December 05, 2017

Overweight or obese patients with rheumatoid arthritis (RA) are significantly less likely to achieve sustained remission than patients with a healthy weight, according to a recent study in Arthritis Care & Research.

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Weight makes RA harder to treat?

Patients with early rheumatoid arthritis (RA) who are overweight or obese are less likely to attain sustained remission than RA patients with healthy weight.

Compared to patients with a healthy body mass index (BMI), overweight patients were 25% less likely and obese patients were 47% less likely to attain sustained remission within 3 years of onset of disease, reported investigators of the Canadian Early Arthritis Cohort (CATCH) Study. These results suggest that excess weight may influence the effect of RA therapies and delay remission, the investigators noted.

“These are the first findings to demonstrate the impact of obesity on achieving sustained remission in an ERA (early rheumatoid arthritis) cohort and lend support to the growing body of evidence linking excess weight with persistent disease activity in ERA,” the authors wrote.

The investigation included 982 patients from the CATCH Study, a multicenter observational trial of ERA patients treated by rheumatologists using guideline-based care. Of these patients, 315 (32%) had a healthy weight (BMI 18.5-24.9), 343 (35%) were overweight (BMI 25-29.9), and 324 (33%) were obese (BMI ≥30). Patients were mostly female (72%), white (85%), and had an average age of 53 years.

Initial treatment was similar for all patients regardless of BMI: 88% were treated with disease modifying anti-rheumatic drugs (DMARDs) and 77% received methotrexate.

A total of 355 patients (36%) achieved sustained remission within the 3-year follow-up period. After controlling for sociodemographic and clinical characteristics, analyses showed that obese patients were the least likely to achieve sustained remission (26%), followed by overweight patients (37%), and patients with a healthy BMI (45%).

The researchers performed additional analyses to further investigate the dose-response relationship between excess weight and sustained remission. They found that very obese patients (BMI >35+) were 53% less likely to achieve sustained remission than patients with a healthy weight.

“These findings have important implications for clinical care since rates of overweight and obesity continue to rise,” said co-author and rheumatologist Susan M. Goodman, MD, of the Hospital for Special Surgery, Weill Cornell Medical College, New York, NY. “Our findings highlight the high proportion of newly diagnosed RA patients who are overweight or obese and who may have disease that is harder to treat. For people with RA who haven’t had an adequate response to treatment, this may be another factor to consider.”

This research was supported through unrestricted grants from Amgen, Pfizer Canada, Hoffmann-LaRoche, UCB Canada, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Biotech, Medexus Inc., Eli Lilly Canada, and Sanofi Canada.

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