Obesity associated with more severe disease flares in early rheumatoid arthritis

Obesity is associated with worse flare symptoms and worse quality of life among patients with early rheumatoid arthritis, researchers reported on Nov. 12, 2023 at ACR Convergence 2023, the annual meeting of the American College of Rheumatology.

“We found that elevated BMI is associated with more severe flare activity and diminished QOL [quality of life], particularly in obese ERA [early rheumatoid arthritis] patients. This result corroborates earlier studies that suggested a systematic underestimation of disease activity in patients with elevated BMI,” the authors said.

Eligibility for enrollment in the study included a baseline diagnosis of 2 or more swollen joints and Early/Recent Onset RA (symptoms ≤12/≤24 months).

At each clinical visit, the researchers calculated the incidence of flares by using the OMERACT RA-Flare Questionnaire (RA-FQ), a patient reported outcomes (PRO)  that assesses symptoms of Pain, Stiffness, Fatigue, and impacts on Physical Function and Social Participation (items scored from 0 to 10; best to worst). All five scores are summed for an overall score range of 0 to 50.

At each clinical visit they also ascertained an Evaluator Global Assessment (EGA) score, a measure of early rheumatoid clinical disease activity between 0 (not active) and 10 (very active).

Using standard statistical tools they evaluated the data from each visit for the correlation between BMI and RA-FQ scores, adjusting for EGA scores and demographic factors.

The investigators enrolled 134 subjects, 85% female, 71% white and 87% non-Hispanic. Forty-six per cent of the subjects were overweight or obese. The median age was 47.3 years, and the median BMI was 24.3.

They reported that elevated EGA scores and elevated BMI emerged as significant predictors of higher RA-FQ scores.

“Our key finding was that there was a linear relationship between having a higher BMI and having a higher RA-FQ score,” said lead study author Margaret Butler, a research assistant in the Department of Medicine at the Hospital for Special Surgery in New York, NY. “As BMI got higher, RA-FQ scores increased as well, indicating that the patient would have poorer outcomes. Having a higher BMI also predicted worse scores in each of the five individual categories except physical function. The relationship was even more pronounced when you separated patients by healthy BMI, overweight BMI, and obese BMI, with patients having an obese BMI having worse RA-FQ scores compared to the other two groups.”

Study principal investigator Vivian Bykerk, MD, at the Hospital for Special Surgery added, “If a person with RA is experiencing frequent flares, weight could be a contributing factor. “It may be helpful for patients to talk with their doctor about how to lose weight.”