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Weight Fluctuation and the Risk of Cardiovascular Events in Patients with Rheumatoid Arthritis


Arthritis Care Res (Hoboken). 2020 Oct 1. doi: 10.1002/acr.24469. Online ahead of print.

Joshua F Baker 1 2 3, George Reed 4 5, Joel Kremer 6 7

Author Information

1 Philadelphia VA Medical Center, Philadelphia, PA, USA.

2 Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA.

3 Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.

4 Corrona Research Foundation, Albany, NY, USA.

5 University of Massachusetts Medical School, Worcester, MA, USA.

6 University of Alabama at Birmingham, Birmingham, Alabama, USA.

7 Albany Medical College and the Center for Rheumatology, Albany, NY, USA.


Purpose: Fluctuations in weight have been linked to cardiovascular (CV) outcomes in the general population. We evaluated whether weight fluctuation was independently predictive of CV events in patients with rheumatoid arthritis (RA).

Methods: We studied patients with RA from the Corrona registry. Weight change was categorized as loss of ≥10%, loss of 5-10%, stable, gain of 5-10%, and gain of ≥10%. We also categorized patients by quintile of variability in weight in prior observation periods. Cox proportional hazard models explored independent associations between time-varying weight change and weight variability and risk of CV events before and after adjusting for CV risk factors, RA disease features, and disability.

Results: Among 31,381 participants, those that lost or gained 10% of their weight had greater disease activity, worse physical function, and were more likely to smoke, have diabetes, use corticosteroids, and be disabled. In adjusted models, a greater risk of CV events was observed in those that experienced 10% weight loss [HR: 1.18 (1.03,1.36) p=0.02] or weight gain [HR 1.20 (1.04,1.38) p=0.01]. The association between weight change and CV events was stronger among participants with BMI <25 kg/m2 for 10% weight loss [HR: 1.34 (1.08,1.66) p=0.001] and 10% weight gain [1.74 (1.41,2.24) p<0.001]. Patients with greater variability in weight had a higher risk of CV events.

Conclusions: Recent changes and high variability in weight predict CV events in RA, particularly among thin patients. Further study is necessary to determine if weight fluctuation has adverse cardiometabolic consequences that are independent of other risk factors.