Obesity, Weight Loss, and Progression of Disability in Rheumatoid Arthritis

Joshua F. Baker, Bryant England, Ted R. Mikuls, Harlan Sayles, Ted R Mikuls, Brian C. Sauer, Michael D. George, Liron Caplan, Kaleb D Michaud

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Cross-sectional studies have demonstrated that obese patients with rheumatoid arthritis (RA) often report greater disability. The longitudinal effects of obesity, however, are not well-characterized. We evaluated associations between obesity, weight loss, and worsening of disability in patients of 2 large registry studies, which included patients who were followed for longer periods of time. Methods: This study included patients with RA from the National Data Bank for 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 Multidimensional HAQ (MD-HAQ) were recorded through follow-up. Significant worsening of disability was defined as an increase of >0.2 in HAQ or MD-HAQ scores. The Cox proportional hazards model was used to evaluate the risk of worsening of disability from baseline and to adjust for demographics, baseline disability, comorbidity, disease duration, and other disease features. Results: At enrollment, disability scores were higher among severely obese patients compared to those who were overweight both in FORWARD (β = 0.17 [95% confidence interval (95% CI) 0.14, 0.20]; P < 0.001) and in the VARA registry (β = 0.17 [95% CI 0.074, 0.27]; P = 0.001). 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 [95% CI 1.18, 1.33] P < 0.001) and in the VARA registry (HR 1.33 [95% CI 1.07, 1.66]; P = 0.01). Weight loss following enrollment was also associated with a greater risk in both cohorts. In the VARA registry, associations were independent of other clinical factors, including time-varying C-reactive protein and swollen joint count. Conclusion: Severe obesity is associated with a more rapid progression of disability in RA. Weight loss is also associated with worsening disability, possibly due to it being an indication of chronic illness and the development of age-related or disease-related frailty.

Original languageEnglish (US)
Pages (from-to)1740-1747
Number of pages8
JournalArthritis Care and Research
Volume70
Issue number12
DOIs
StatePublished - Dec 2018

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Weight Loss
Rheumatoid Arthritis
Obesity
Registries
Veterans
Confidence Intervals
ametantrone
Health
Morbid Obesity
Rheumatic Diseases
Proportional Hazards Models
C-Reactive Protein
Comorbidity
Chronic Disease
Cross-Sectional Studies
Joints
Demography
Databases
Surveys and Questionnaires

ASJC Scopus subject areas

  • Rheumatology

Cite this

Obesity, Weight Loss, and Progression of Disability in Rheumatoid Arthritis. / Baker, Joshua F.; England, Bryant; Mikuls, Ted R.; Sayles, Harlan; Mikuls, Ted R; Sauer, Brian C.; George, Michael D.; Caplan, Liron; Michaud, Kaleb D.

In: Arthritis Care and Research, Vol. 70, No. 12, 12.2018, p. 1740-1747.

Research output: Contribution to journalArticle

Baker, Joshua F. ; England, Bryant ; Mikuls, Ted R. ; Sayles, Harlan ; Mikuls, Ted R ; Sauer, Brian C. ; George, Michael D. ; Caplan, Liron ; Michaud, Kaleb D. / Obesity, Weight Loss, and Progression of Disability in Rheumatoid Arthritis. In: Arthritis Care and Research. 2018 ; Vol. 70, No. 12. pp. 1740-1747.
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abstract = "Objective: Cross-sectional studies have demonstrated that obese patients with rheumatoid arthritis (RA) often report greater disability. The longitudinal effects of obesity, however, are not well-characterized. We evaluated associations between obesity, weight loss, and worsening of disability in patients of 2 large registry studies, which included patients who were followed for longer periods of time. Methods: This study included patients with RA from the National Data Bank for 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 Multidimensional HAQ (MD-HAQ) were recorded through follow-up. Significant worsening of disability was defined as an increase of >0.2 in HAQ or MD-HAQ scores. The Cox proportional hazards model was used to evaluate the risk of worsening of disability from baseline and to adjust for demographics, baseline disability, comorbidity, disease duration, and other disease features. Results: At enrollment, disability scores were higher among severely obese patients compared to those who were overweight both in FORWARD (β = 0.17 [95{\%} confidence interval (95{\%} CI) 0.14, 0.20]; P < 0.001) and in the VARA registry (β = 0.17 [95{\%} CI 0.074, 0.27]; P = 0.001). 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 [95{\%} CI 1.18, 1.33] P < 0.001) and in the VARA registry (HR 1.33 [95{\%} CI 1.07, 1.66]; P = 0.01). Weight loss following enrollment was also associated with a greater risk in both cohorts. In the VARA registry, associations were independent of other clinical factors, including time-varying C-reactive protein and swollen joint count. Conclusion: Severe obesity is associated with a more rapid progression of disability in RA. Weight loss is also associated with worsening disability, possibly due to it being an indication of chronic illness and the development of age-related or disease-related frailty.",
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T1 - Obesity, Weight Loss, and Progression of Disability in Rheumatoid Arthritis

AU - Baker, Joshua F.

AU - England, Bryant

AU - Mikuls, Ted R.

AU - Sayles, Harlan

AU - Mikuls, Ted R

AU - Sauer, Brian C.

AU - George, Michael D.

AU - Caplan, Liron

AU - Michaud, Kaleb D

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N2 - Objective: Cross-sectional studies have demonstrated that obese patients with rheumatoid arthritis (RA) often report greater disability. The longitudinal effects of obesity, however, are not well-characterized. We evaluated associations between obesity, weight loss, and worsening of disability in patients of 2 large registry studies, which included patients who were followed for longer periods of time. Methods: This study included patients with RA from the National Data Bank for 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 Multidimensional HAQ (MD-HAQ) were recorded through follow-up. Significant worsening of disability was defined as an increase of >0.2 in HAQ or MD-HAQ scores. The Cox proportional hazards model was used to evaluate the risk of worsening of disability from baseline and to adjust for demographics, baseline disability, comorbidity, disease duration, and other disease features. Results: At enrollment, disability scores were higher among severely obese patients compared to those who were overweight both in FORWARD (β = 0.17 [95% confidence interval (95% CI) 0.14, 0.20]; P < 0.001) and in the VARA registry (β = 0.17 [95% CI 0.074, 0.27]; P = 0.001). 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 [95% CI 1.18, 1.33] P < 0.001) and in the VARA registry (HR 1.33 [95% CI 1.07, 1.66]; P = 0.01). Weight loss following enrollment was also associated with a greater risk in both cohorts. In the VARA registry, associations were independent of other clinical factors, including time-varying C-reactive protein and swollen joint count. Conclusion: Severe obesity is associated with a more rapid progression of disability in RA. Weight loss is also associated with worsening disability, possibly due to it being an indication of chronic illness and the development of age-related or disease-related frailty.

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