Obesity in Rheumatoid Arthritis

Physical activity is advised for patients with chronic inflammatory arthritis as this helps relieve some symptoms such as stiffness and pain. While the inflammatory process takes it’s toll on the patient’s body (patients also complain of malaise, anorexia and fatigue), we still encounter obese patients suffering from these conditions. Should this be a reason for worry?

Image from http://www.drsharma.ca

A recent meta-analyses suggest that obese rheumatoid arthritis patients do poorly compared to their normal and overweight (but non-obese) counterparts. Yang Liu and colleagues (2016) screened 3,368 journals – including 9 which reported disease activity measures, 8 which looked into remission rates and 3 which examined mortality. According to the meta-analysis, obese patients were less likely to achieve remission compared to their non-obese counterparts (odds ratio 0.57 95% CI 0.45-0.72). Furthermore, sustained remissions were also less likely in obese patients (odds ratio 0.49 95% CI 0.32-0.74). That’s basically saying that obese rheumatoid arthritis patients have a 50% less chance of achieving and sustaining remission compared to their non-obese counterparts.

Studies reporting disease activity measures were not suitable for meta-analyses but showed a trend for worse disease activity scores, tender joint counts, patient global assessment of disease activity, pain and physician function scores and inflammatory markers. Surprisingly, the 3 studies looking into mortality did not show an association with obesity in this analysis.

Probably, the next step in this field would be to evaluate whether weight loss strategies would improve remission rates and disease activity measures in rheumatoid arthritis.

Reference: Liu Y et al. The impact of obesity on remission and disease activity in rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Care Res 2016. DOI: 10.1002/acr.22932.

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