Abstract
Purpose
We assessed the impact of adjustment of the multi-biomarker disease activity score (MBDA) for age, sex, and leptin, over the range of age and adiposity, and assessed relationships with clinical disease activity.
Methods
Patients with RA, ages 18–75 years, were recruited from clinical practices and completed whole-body DXA to quantify fat mass indices (FMI, kg/m2). FMI Z-scores were calculated based on distributions in a reference population. Descriptive statistics described relationships between age, FMI Z-score, and the original MBDA and adjusted MBDA (aMBDA). Swollen joint counts (SJC) and the clinical disease activity index (CDAI) were assessed over MBDA categories.
Results
There were 104 participants (50% female) with mean (SD) age of 56.1 (12.5) and body mass index (BMI) of 28.8 (6.9). Older age was associated with higher MBDA scores in men. The aMBDA was not associated with age. The original MBDA score was associated with FMI Z-score among women (Rho = 0.42, p = 0.002) but not men. The aMBDA was not associated with FMI Z-score in either women or men. The aMBDA score was lower than the original MBDA in the highest quartile of FMI in women and was higher in the lowest FMI quartiles in women and men. CDAI, SJC, and radiographic scores were similar across activity categories for the original MBDA score and aMBDA.
Conclusions
The aMBDA demonstrated reduced associations with adiposity, particularly among women. The aMBDA may be less likely to overestimate disease activity in women with greater adiposity and to underestimate disease activity in men and women with lesser adiposity.
Key Points • Leptin adjustment of the MBDA score reduces the influence of adiposity, particularly among women. • Leptin adjustment results in significantly higher estimated disease activity in thin men and women. • The adjusted and unadjusted score correlate similarly with clinical disease activity measures. |
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Acknowledgments
Dr. Baker would like to acknowledge the support of a Veterans Affairs Clinical Science Research & Development Career Development Award (IK2 CX000955) and support of a VA Merit Award (I01 CX001703).
Funding
This work (Dr. Baker) was supported by a Veterans Affairs Clinical Science Research and Development Career Development Award and VA Merit Award (IK2 CX000955, I01 CX001703) and by the University of Pennsylvania Clinical and Translational Research Center (UL1 RR024134). Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001878. MDG was supported by NIAMS K23 (AR073931-01).
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The protocol was approved by the Institutional Review Board at the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center. Informed consent was obtained from all participants.
Conflict of interest
JFB has received consulting fees from Bristol Myers Squibb, Gilead, and Burns-White, LLC. JC has received research grants and consulting fees from Myriad Genetics. Myriad Genetics performed MBDA scores on stored serum for no cost. MDG has received consulting fees from Bristol Myers Squibb.
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Baker, J.F., Curtis, J.R., Chernoff, D. et al. Evaluation of the impact of age and adiposity on a multi-biomarker disease activity score before and after adjustment. Clin Rheumatol 40, 2419–2426 (2021). https://doi.org/10.1007/s10067-020-05508-3
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DOI: https://doi.org/10.1007/s10067-020-05508-3