Original Article

Clinical Rheumatology

, Volume 28, Issue 4, pp 439-444

First online:

Underweight and obese states both associate with worse disease activity and physical function in patients with established rheumatoid arthritis

  • Antonios Stavropoulos-KalinoglouAffiliated withSchool of Sport, Performing Arts and Leisure, Wolverhampton UniversityResearch Institute in Healthcare Science, University of WolverhamptonDepartment of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital Email author 
  • , Giorgos S. MetsiosAffiliated withSchool of Sport, Performing Arts and Leisure, Wolverhampton UniversityResearch Institute in Healthcare Science, University of WolverhamptonDepartment of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital
  • , Vasileios F. PanoulasAffiliated withDepartment of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital
  • , Alan M. NevillAffiliated withSchool of Sport, Performing Arts and Leisure, Wolverhampton UniversityResearch Institute in Healthcare Science, University of Wolverhampton
  • , Athanasios Z. JamurtasAffiliated withDepartment of Sport and Exercise Science, University of ThessalyInstitute of Human Performance and Rehabilitation
  • , Yiannis KoutedakisAffiliated withSchool of Sport, Performing Arts and Leisure, Wolverhampton UniversityDepartment of Sport and Exercise Science, University of ThessalyInstitute of Human Performance and Rehabilitation
  • , George D. KitasAffiliated withResearch Institute in Healthcare Science, University of WolverhamptonDepartment of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall HospitalARC Epidemiology Unit, University of Manchester

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Abstract

Obesity is characterised by low-grade inflammation and could potentially affect disease activity and severity in patients with rheumatoid arthritis (RA). Body mass index (BMI), body fat (BF), erythrocyte sedimentation rate, C-reactive protein, disease activity score 28, physical function (health assessment questionnaire) and presence of erosions and joint surgery were assessed in 294 (female = 219) volunteers with established RA [age 63.3 (56.2–69.6); disease duration 13 (7–20) years]. Smoking status, rheumatoid factor and anti-cyclic citrullinated peptide positivity were also assessed. BMI and BF independently associated with disease characteristics. Compared to normal-weight patients, underweight and obese had higher C-reactive protein (p = 0.046) and physical dysfunction (p = 0.034). BMI or BF did not associate with presence of erosions or joint surgery. In patients with established RA, both very low and very high BMI and BF associate independently with increased disease activity and physical dysfunction; however, this does not seem to associate with presence of erosions or joint surgery. Further longitudinal studies are required to address this apparent dissociation.

Keywords

Body weight Body mass index Obesity Percentage body fat Rheumatoid arthritis outcome