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Obesity, Weight Loss Linked with Disability in RA
Arthritis Care Res; ePub 2018 Apr 29; Baker, et al
Severe obesity is associated with more rapid progression of disability in rheumatoid arthritis (RA), according to a recent study. However, 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. Researchers included patients with RA from the National Data Bank of Rheumatic Diseases (Forward) (n=23,323) and the Veterans Affairs RA (VARA) registry study (n=1,697). Results of the Health Assessment Questionnaire (HAQ) or Multi‐Dimensional (MD)‐HAQ were recorded over follow‐up. Significant worsening was defined as an increase of HAQ or MD‐HAQ of >0.2. They found:
- At enrollment, disability scores were higher among severely obese patients compared to overweight in both Forward [B: 0.17 (0.14, 0.20)] and VARA [B: 0.17 (0.074, 0.27)].
- 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)] and VARA [HR 1.33 (1.07, 1.66)].
- Weight loss following enrollment was also associated with a greater risk in both cohorts.
Baker JF, England BR, Mikuls TR, et al. Obesity, weight loss, and progression of disability in rheumatoid arthritis. [Published online ahead of print April 29, 2018]. Arthritis Care Res. doi:10.1002/acr.23579.
This study concluded that severe obesity, as well as weight loss, was associated with rapid progression of disability in rheumatoid arthritis (RA). However, severely obese patients had higher disability scores than did overweight patients. Severely overweight patients also had a greater risk of progressive disability as opposed to overweight patients. RA patients who are severely obese need to consider weight loss since disability scores significantly increase with severe obesity. Although this study includes the frequency at which daily activities are performed, future studies should focus other measures of disability, as well as include equal numbers of male and female participants.—Harold E. Paulus, MD; Emeritus Professor; University of California, Los Angeles; Division of Rheumatology.