Impact of Obesity and Adiposity on Inflammatory Markers in Patients With Rheumatoid Arthritis
Impact of Obesity and Adiposity on Inflammatory Markers in Patients With Rheumatoid Arthritis
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DOI：
10.1002/acr.23229
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发表时间：
2017-12-01
影响因子：
4.7
通讯作者：
Baker, Joshua F.
中科院分区：
文献类型：
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作者：
George, Michael D.;Giles, Jon T.;Baker, Joshua F.
目标。c反应蛋白（CRP）水平和红细胞沉降率（ESR）是类风湿关节炎（RA）重要的疾病活动性生物标志物。本研究旨在确定肥胖在多大程度上影响了这些生物标志物。在2个RA队列中评估了身体质量指数（BMI）与CRP水平和ESR的关联：横断面身体组成（BC）队列（n = 451），包括全身双x线吸收仪测量的脂肪质量指数；和纵向退伍军人事务类风湿性关节炎（VARA）登记（n = 1,652），使用按性别分层的多变量模型。为了进行比较，使用国家健康和营养检查调查对普通人群进行了关联评估。在患有RA的女性和一般人群中，较高的BMI与较高的CRP水平相关，特别是在严重肥胖的女性中(BMI = 35 kg/m（2)与20-25 kg/m(2)相比，P < 0.001）。在调整关节计数和患者整体健康评分后，这种关联仍然存在（BC P < 0.001, VARA P < 0.01），但在调整脂肪质量指数后，这种关联减弱（P = 0.17）。在女性中，BMI和ESR之间的正相关则较为温和。在患有RA的男性中，较低的BMI与较高的CRP水平和ESR相关，而在普通人群中则呈正相关。肥胖与RA患者较高的CRP水平和ESR有关。这种关联与脂肪量有关，而与类风湿性关节炎疾病活动无关。低BMI与RA患者较高的CRP水平相关；这一意外发现仍未完全解释清楚，但很可能不是肥胖的直接影响。
Objective. The C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) are important disease activity biomarkers in rheumatoid arthritis (RA). This study aimed to determine to what extent obesity biases these biomarkers.Methods. Body mass index (BMI) associations with CRP level and ESR were assessed in 2 RA cohorts: the cross-sectional Body Composition (BC) cohort (n = 451), including whole-body dual x-ray absorptiometry measures of fat mass index; and the longitudinal Veterans Affairs Rheumatoid Arthritis (VARA) registry (n = 1,652), using multivariable models stratified by sex. For comparison, associations were evaluated in the general population using the National Health and Nutrition Examination Survey.Results. Among women with RA and in the general population, greater BMI was associated with greater CRP levels, especially among women with severe obesity (P < 0.001 for BMI >= 35 kg/m(2) versus 20-25 kg/m(2)). This association remained after adjustment for joint counts and patient global health scores (P < 0.001 in BC and P < 0.01 in VARA), but was attenuated after adjustment for fat mass index (P = 0.17). Positive associations between BMI and ESR in women were more modest. In men with RA, lower BMI was associated with higher CRP levels and ESR, contrasting with positive associations among men in the general population.Conclusion. Obesity is associated with higher CRP levels and ESR in women with RA. This association is related to fat mass and not RA disease activity. Low BMI is associated with higher CRP levels in men with RA; this unexpected finding remains incompletely explained but likely is not a direct effect of adiposity.