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Abdominal Obesity in Comparison with General Obesity and Risk of Developing Rheumatoid Arthritis in Women


J Rheumatol. 2020 Jul 15;jrheum.200056. doi: 10.3899/jrheum.200056. Online ahead of print.

Nathalie E Marchand 1, Jeffrey A Sparks 1, Sara K Tedeschi 1, Susan Malspeis 1, Karen H Costenbader 1, Elizabeth W Karlson 1, Bing Lu 1

Author Information

1 From the Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, MA. This work was supported by the National Institutes of Health (grant numbers: AR071326, AR061362, AR047782, AR049880, AR059073, AR069688, UM1 CA186107, UM1 CA176726). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Address correspondence to Bing Lu Division of Rheumatology, Inflammation and Immunity Brigham & Women's Hospital 60 Fenwood Rd - 0616v, Boston, MA 02115. Email: blu1@bwh.harvard.edu.


Objective: Being overweight or obese increases rheumatoid arthritis (RA) risk among women, particularly among those diagnosed at younger age. Abdominal obesity may contribute to systemic inflammation more than general obesity, thus we investigated whether abdominal obesity, compared with general obesity, predicted RA risk in 2 prospective cohorts, the Nurses' Health Study (NHS) and NHS II.

Methods: We followed 50,682 women (1986-2014) in NHS and 47,597 women (1993-2015) in NHS II, without RA at baseline. Waist circumference (WC), body mass index (BMI), health outcomes and covariate data were collected through biennial questionnaires. Incident RA cases and serologic status were identified by chart review. We examined the associations of WC and BMI with RA risk using time-varying Cox proportional hazards models. We repeated analyses restricted to age ≤55 years.

Results: During 28 years of follow-up, we identified 844 incident RA cases (527 NHS, 317 NHS II). Women with WC >35 inches (88 cm) had increased RA risk (HR 1.22, 95% CI 1.06-1.41). A similar association was observed for seropositive RA, which was stronger among young and middle-aged women. Further adjustment for BMI attenuated the association to null. In contrast, BMI was associated with RA (HRBMI ≥30vs<25 1.33, 95% CI 1.05-1.68) and seropositive RA, even after adjusting for WC, and, as in WC analyses, this association was stronger among young and middle-aged women.

Conclusion: Abdominal obesity was associated with increased RA risk, particularly for seropositive RA, among young and middle-aged women, however, it did not independently contribute to RA risk beyond general obesity.