Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: A long-term followup from disease onset
Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: A long-term followup from disease onset
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DOI：
10.1002/acr.21710
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发表时间：
2013-01-01
影响因子：
4.7
通讯作者：
Hafstrom, Ingiald
中科院分区：
文献类型：
--
作者：
Ajeganova, Sofia;Andersson, Maria L.;Hafstrom, Ingiald
目的探讨肥胖与类风湿关节炎（RA）活动性和严重程度的关系，以及肥胖与RA合并症的关系。肥胖定义为体重指数（BMI）≥ 30或≥ 28 kg/m2或腰围（WC）。方法研究人群包括1,596例早期RA患者（平均± SD年龄55.6 ± 14.6岁，67.8%为女性），他们从1992年至2006年被纳入更好的抗风湿药物治疗观察性研究。2010年，通过邮寄问卷收集了1，391名患者的生活方式因素和合并症数据。临床结局为28个关节的疾病活动性评分、持续缓解、身体功能（健康评估问卷[HAQ]）、视觉模拟量表评估的疼痛和总体健康以及预定义的合并症。结果在平均+/- SD 9.5 +/- 3.7年后，平均+/- SD BMI从25.4 +/- 4.2增加到26.0 +/- 4.5 kg/m2（P = 0.000）。基线时BMI ≥ 30 kg/m2的患病率为12.9%，随访时为15.8%。在多变量回归分析中，BMI和肥胖（定义为BMI =30或=28 kg/m2）在入选和调查时与疾病活动性较高、持续缓解患者较少、HAQ评分较高、疼痛较多和总体健康状况较差独立相关。此外，BMI和肥胖独立地赋予被诊断患有高血压、糖尿病和慢性肺病的更高几率。此外，BMI和WC与心绞痛/急性心肌梗死/冠状动脉血运重建独立相关。相反，没有一个肥胖变量与中风或短暂性脑缺血发作的患病率相关。观察期间生活方式的改变，如戒烟或饮食改变，对结果没有影响。结论肥胖与RA疾病预后差和合并症患病率高相关。建议进行身体测量，以改善对疾病进程的预测。
Objective To determine the association of obesity, defined as a body mass index (BMI) =30 or =28 kg/m2 or by waist circumference (WC), with disease activity and severity, as well as its relationship to comorbidities in rheumatoid arthritis (RA). Methods The study population comprised 1,596 patients with early RA (mean +/- SD age 55.6 +/- 14.6 years, 67.8% women) who had been included in the Better Anti-Rheumatic Farmacotherapy observational study from 19922006. In 2010, data on lifestyle factors and comorbidities were collected through a postal questionnaire, answered by 1,391 patients. Clinical outcomes were the Disease Activity Score in 28 joints, sustained remission, physical function (Health Assessment Questionnaire [HAQ]), and pain and global health assessed on a visual analog scale, as well as predefined comorbidities. Results After a mean +/- SD of 9.5 +/- 3.7 years, the mean +/- SD BMI had increased from 25.4 +/- 4.2 to 26.0 +/- 4.5 kg/m2 (P = 0.000). The prevalence of BMI =30 kg/m2 was 12.9% at baseline and 15.8% at followup. In multivariable regression, BMI and obesity, defined as a BMI =30 or =28 kg/m2, 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.