The results of a
study presented at EULAR 2019 demonstrate significant correlation between body
mass index (BMI) and disease severity in psoriatic arthritis (PsA).
Although PsA has been associated with an enhanced
prevalence of obesity and being overweight, few studies have assessed the
relationship between weight and the severity of disease in these patients.
Results of this study demonstrate BMI is independently
correlated to disease activity (p=0.026), patient-perceived disease impact
(p<0.0001), and disability (p<0.0001). In patients with PsA classified as
obese or non-obese, disease activity measure cDAPSA (range 0-154) was 33.4 vs
27.7, patient-perceived disease impact measure PsAID-12 (range 0-10) was 6.3 vs
5.3, and disability measure HAQ-DI (range 0-3) was 1.36 vs 1.03 respectively.
“Our results highlight the impact of obesity and need for
lifestyle-directed approaches to manage weight in psoriatic arthritis in
parallel to joint and skin focused treatments,” said Dr Stefan Siebert,
Clinical Senior Lecturer in Inflammation and Rheumatology, University of
Glasgow, UK.
The study included 917 patients across eight European
countries as part of the PsABio study, an ongoing prospective observational
study evaluating patients with PsA receiving ustekinumab or tumour necrosis
factor inhibitors. Data were collected on disease severity and impact, and
analysed using multiple regression models adjusted for age, sex, smoking, body
surface area, C-reactive protein, disease duration and biologic treatment.
“There is growing evidence describing how fat tissue acts
as an active organ involved in metabolic and inflammatory disorders,” said Prof
John D Isaacs, Chairperson of the Abstract Selection Committee, EULAR.
“Furthermore, with fixed-dose drug regimens, as with
self-injected biologics, obesity can reduce efficacy for pharmacokinetic
reasons. These factors, alongside the global epidemic of overweight and
obesity, makes research in this area of great relevance and interest.”
Another study presented at EULAR 2019 provides evidence
for the adipokine, adiponectin, in predicting the development of rheumatoid
arthritis (RA) in overweight subjects.
Adipokines are signalling molecules that are secreted by fat
tissue and act in a similar way to hormones. Raised levels of adiponectin, a
type of adipokine, have been shown in subjects with RA, however, results of
this study suggest it could have a role in predicting the onset of disease.
“Early detection and management of rheumatoid arthritis is
very important to improve disease outcomes in patients,” said Dr Cristina
Maglio, University of Gothenburg, Gothenburg, Sweden. “Our analysis suggests
that serum adiponectin in overweight patients might have a role as a biomarker
for early rheumatoid arthritis.”
The analysis included two studies – the first included 82
subjects with obesity and available measurements of adiponectin before the
development of RA and 410 matched controls and demonstrated a 10 per cent
increased risk of developing RA in those with raised serum adiponectin at
baseline. The second study included 88 sex- and age-matched pairs and
demonstrated a 20 per cent increased risk, but only in those with a BMI greater
than 25.
Finally, another interesting study presented at EULAR 2019
looked at overweight and obesity in young patients with juvenile idiopathic
arthritis (JIA).
Results found the rate of being overweight and obesity in
children and adolescents with JIA is comparative to the general population.
However, further analysis revealed a number of factors are
significantly associated with being overweight in the JIA group including
increasing age (OR: 1.06, 95% CI: 1.04-1.09), male gender (OR: 1.21, 95% CI:
1.04-1.44), functional limitations (OR: 1.29, 95% CI: 1.04-1.59), therapy with
biological DMARDs (OR: 1.48, 95% CI: 1.22-1.80), and systemic glucocorticoids
(OR: 1.40, 95% CI: 1.14-1.71).
The implications of
these findings on the long-term outcome of JIA requires further study.
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