PHILADELPHIA—Obese patients with rheumatoid arthritis report greater disability in cross-sectional studies, but what that means over the long term has not been studied often.
An article published in Arthritis Care & Research discussed evaluation of associations among obesity, weight loss and worsening of disability in two large registry studies with long-term follow-up.1
Philadelphia VAMC-led researchers included 23,323 patients with RA from the National Data Bank of Rheumatic Diseases (Forward) and the 1,697 patients from the VARA registry study. During the study, results of the Health Assessment Questionnaire (HAQ) or Multi-Dimensional (MD)-HAQ.
An increase of HAQ or MD-HAQ of &rt;0.2 was defined as significant worsening. The study team analyzed the risk of worsening from baseline, adjusting for demographics, baseline disability, comorbidity, disease duration and other disease features.
At enrollment, disability scores were higher among severely obese patients compared to overweight in both Forward [B: 0.17 (0.14, 0.20) p<0.001] and VARA [B: 0.17 (0.074, 0.27) p=0.001], the report noted.
Results indicated that, in multivariable models, patients who were severely obese at enrollment had a greater risk of progressive disability compared to overweight patients in Forward [HR 1.25 (1.18, 1.33) p<0.001] and VARA [HR 1.33 (1.07, 1.66) p=0.01].
Interestingly, weight loss following enrollment also was associated with a greater risk in both cohorts. Researchers pointed out that the associations were independent of other clinical factors, including time-varying C-reactive protein and swollen joint count in VARA.
“Severe obesity is associated with more rapid progression of disability in RA,” study authors concluded. “Weight loss is also associated with worsening disability, possibly by identifying individuals with chronic illness and the development of age-related or disease-related frailty.”