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Overweight and Obesity Reduce the Likelihood of Achieving Sustained Remission in Early Rheumatoid Arthritis: Results from the Canadian Early Arthritis Cohort Study

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Schulman E1, Bartlett SJ2, Schieir O3, Andersen KM1, Boire G4, Pope JE5, Hitchon C6, Jamal S7, Thorne CJ8, Tin D8, Keystone EC9, Haraoui B10, Goodman SM1, Bykerk VP1,9, Investigators C. Arthritis Care Res (Hoboken). 2017 Nov 30. doi: 10.1002/acr.23457. [Epub ahead of print]


1 Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.

2 Divisions of Clinical Epidemiology, Rheumatology, and Respiratory Clinical Trials Unit, McGill University, Montreal, QC, Canada.

3 University of Toronto, Toronto, Canada.

4 Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC, Canada.

5 Division of Rheumatology, St. Joseph's Health Care London, University of Western Ontario, London, ON, Canada.

6 Arthritis Center, University of Manitoba, Winnipeg, MB, Canada.

7 University of British Columbia, Vancouver, BC, Canada.

8 Southlake Regional Health Centre, Newmarket, ON, Canada.

9 Rebecca McDonald Center for Arthritis & Autoimmune Disease, Mount Sinai Hospital, University of Toronto, ON, Canada.

10 Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, QC, Canada.


OBJECTIVE: Obesity is implicated in RA development, severity, outcomes and treatment response. We estimated the independent effects of overweight and obesity on ability to achieve sustained remission (sREM) in the three years following RA diagnosis.

METHODS: Data were from the Canadian Early Arthritis Cohort, a multicenter observational trial of ERA patients treated by rheumatologists using guideline-based care. sREM was defined as DAS28 <2.6 for two consecutive visits. Patients were stratified by BMI (healthy [18.5-24.9]; overweight [25-29.9]; and obese [≥30]). Cox regression was used to estimate the effect of BMI category on probability of achieving sREM over the first 3 years, controlling for age, sex, race, education, RA duration, smoking status, comorbidities, baseline DAS28, HAQ-DI, CRP, and initial treatment.

RESULTS: Of 982 patients, 315 (32%) had a healthy BMI, 343 (35%) were overweight, and 324 (33%) were obese; 355 (36%) achieved sREM within 3 years. Initial treatment did not differ by BMI category. Compared to healthy BMI, overweight (HR= 0.75, 95% CI 0.58-0.98) and obese (HR= 0.53, 95% CI: 0.39-0.71) patients were significantly less likely to achieve sREM.

CONCLUSION: Rates of overweight and obesity were high (69%) in this ERA cohort. Overweight patients were 25%, and obese patients were 47% less likely to achieve sREM in the first 3 years despite similar initial DMARD treatment and subsequent biologic use. This is the largest study demonstrating the negative impact of excess weight on RA disease activity and supports a call to action to better identify and address this risk in RA patients.