Being overweight may affect psoriatic arthritis disease severity
Being overweight may have an impact on disease severity in psoriatic arthritis, according to a study presented at EULAR 2019.
The PsABio* study was conducted in eight European countries and involved 917 patients (mean age 49.7 years, 55.5 percent female) who recently initiated treatment with either tumour necrosis factor (TNF) inhibitors or ustekinumab (n=467 and 450, respectively). Of the 827 patients included in the current analysis (mean BMI 28.1 kg/m2), 40 percent were classified as overweight (BMI >25 to 30 kg/m2) and 30.4 percent classified as obese (BMI >30 kg/m2).
Compared with non-obese patients with psoriatic arthritis, patients who were classified as obese had more swollen joints (mean, 6.8 vs 5.1), and higher levels of the disease activity measure cDAPSA** (mean, 33.4 vs 27.7), disability as measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI; mean, 1.36 vs 1.03), and patient-perceived disease impact as measured on the PsAID-12*** questionnaire (mean, 6.3 vs 5.3). [EULAR 2019, abstract OP0007]
Multiple regression modelling suggested an independent association between a higher BMI and higher levels of cDAPSA (β=0.09; p=0.026), as well as PsAID-12*** (β=0.16; p<0.0001) and HAQ-DI (β=0.21; p<0.0001).
“This multi-country routine-care cohort of [psoriatic arthritis] patients in need of biologic treatment confirms the high prevalence of overweight/obesity and indicates an independent association between high BMI and disease activity as well as patient-reported impact of disease and disability,” said the authors led by Dr Stefan Siebert from the University of Glasgow, Glasgow, UK.
“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,” he said.
In another study, researchers used data from the German National Paediatric Rheumatologic Database (NPRD) to identify 6,860 children and adolescents who were diagnosed with juvenile idiopathic arthritis (JIA; mean age 11.5 years, 67 percent female, mean duration of JIA 4.6 years).
Fourteen percent of the study population were classified as being overweight, including 6 percent who were classified as obese. The prevalence was similar to that of the overall German population, which has a 15 and 6 percent rate of overweight and obesity, respectively. There was a higher rate of overweight among boys than girls with JIA (16 percent vs 14 percent; p<0.05), and patients with psoriatic arthritis and JIA had the highest rates of overweight (20 and 18 percent, respectively). [EULAR 2019, abstract OP0259]
Increasing age and male sex were associated with an increased risk of being overweight (odds ratio [OR], 1.06, 95 percent confidence interval [CI], 1.04–1.09 and OR, 1.21, 95 percent CI, 1.01–1.44, respectively), as were functional limitations (OR, 1.29, 95 percent CI, 1.04–1.59), and treatment with biological DMARDs# (OR, 1.48, 95 percent CI, 1.22–1.80) or systemic glucocorticoids (OR, 1.40, 95 percent CI, 1.14–1.71).
“The overweight rate increases with age and is strongly associated with functional restrictions and treatment with glucocorticoids. The role of overweight in the long-term outcome of JIA is an issue that still needs to be addressed,” said Dr Florian Milatz from the German Rheumatism Research Centre, Berlin, Germany, and co-authors.
“There is growing evidence describing how fat tissue acts as an active organ involved in metabolic and inflammatory disorders,” said Professor John D. Isaacs, chairperson of the Abstract Selection Committee, EULAR 2019.
“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,” he said.