Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (6): 993-999. doi: 10.19723/j.issn.1671-167X.2023.06.006

Previous Articles     Next Articles

Correlation analysis between body mass index and clinical characteristics of rheumatoid arthritis

Jing-feng ZHANG,Yin-ji JIN,Hui WEI,Zhong-qiang YAO,Jin-xia ZHAO*()   

  1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2023-08-18 Online:2023-12-18 Published:2023-12-11
  • Contact: Jin-xia ZHAO E-mail:zhao-jinxia@163.com
  • Supported by:
    the Clinical Cohort Construction Program of Peking University Third Hospital(BYSYDL2022017)

RICH HTML

 6   

PDF (PC)

148

Abstract:

Objective: To analyze the clinical features of overweight and obese rheumatoid arthritis (RA)patients, and the relationship between body mass index (BMI) and disease characteristics. Methods: The demographic data, extra-articular manifestations, comorbidities, and disease activity of RA patients admitted to the Rheumatology and Immunology Department of Peking University Third Hospital from January 2015 to December 2020 were collected, and the above characteristics of overweight and obese RA patients were retrospectively analyzed. According to the WHO, BMI≥30 kg/m2 referred to obese individuals, 25≤BMI < 30 kg/m2 referred to overweight individuals, 18.5≤BMI < 25 kg/m2 referred to normal individuals, BMI < 18.5 kg/m2 referred to reduced body mass individuals. t test was used for the quantitative data in accordance with normal distribution. Wilcoxon rank sum test was used for the quantitative data of non-normal distribution. The qualitative data were analyzed by chi square test. But while 1≤theoretical frequency < 5, Chi square test of corrected four grid table was used. And Fisher exact probability method was used when theoretical frequency < 1. Analyzing whether overweight or obesity was associated with comorbidities using Logistic regression adjusted confounding factors. Results: A total of 481 RA patients were included in this study, with an average BMI value of (23.28±3.75) kg/m2.Of the patients, 31 cases (6.5%) were with BMI < 18.5 kg/m2, 309 cases (64.2%) with 18.5≤ BMI < 25 kg/m2, amounting to 340 cases (70.7%). There were 119 overweight individuals (25≤ BMI < 30 kg/m2, 24.7%) and 22 obese individuals (BMI≥30 kg/m2, 4.6%), totaling 141 (29.3%).The proportion of the overweight and obese RA patients suffering from hypertension (57.4% vs. 39.1%, P < 0.001), diabetes (25.5% vs. 15.0%, P=0.006), hyperlipidemia (22.7% vs. 10.9%, P=0.001), fatty liver (28.4% vs. 7.4%, P < 0.001), osteoarthritis (39.0% vs. 29.4%, P=0.040) was significantly higher, and the proportion of the patients with osteoporosis(59.6% vs. 70.9%, P=0.016) and anemia (36.2% vs. 55.6%, P < 0.001) was significantly lower. However, there was no difference between the two groups in coronary heart disease (5.7% vs. 7.6%, P=0.442), cerebrovascular disease (6.4% vs. 8.8%, P=0.372) and peripheral atherosclerosis (9.2% vs. 7.6%, P=0.565).The median C-reactive protein (CRP, 1.52 mg/dL vs. 2.35 mg/dL, P=0.008), median erythrocyte sedimentation rate (ESR, 34.0 mm/h vs. 50.0 mm/h, P=0.003), pain visual simulation score (VAS) (3.66±3.08 vs. 4.40±2.85, P=0.011), and 28 joint disease activity scores (DAS-28, 5.05±1.60 vs. 5.45±1.52, P=0.010) in the overweight and obese RA group were all lower than those in the normal and reduced weight groups. Multivariate regression analysis showed that overweight and obesity was an independent risk factor for hypertension, diabetes, hyperlipidemia and fatty liver, and had protective effects on osteoporosis and anemia. Conclusion: In RA patients, RA disease activity is lower in overweight and obesity patients. Overweight and obesity is associated with hypertension, diabetes and hyperlipidemia, but not with cardiovascular and cerebrovascular diseases.

Key words: Rheumatoid arthritis, Body mass index, Disease activity

CLC Number: 

  • R593.2

Table 1

Comparison of demographic data and disease characteristics between overweight and obesity, as well as normal and reduced weight RA patients"

Items Total BMI＜25 kg/m2 BMI≥25 kg/m2 t/Z/χ2 P
Age/years, $\bar x \pm s$ 58.6±14.1 58.6±15.0 58.7±11.8 -0.135 0.893
Age of onset/years, $\bar x \pm s$ 49.8±15.8 49.9±16.2 49.7±14.7 0.067 0.947
Course of disease /years, M(IQR) 5.0 (12.0) 5.0 (13.0) 5.0 (12.0) -0.270 0.787
Women, n (%) 356 (74.0) 246 (72.4) 110 (78.0) 1.661 0.198
Men, n (%) 125 (26.0) 94 (27.6) 31 (22.0) 1.661 0.198
Smoking, n (%) 90 (18.7) 67 (19.7) 23 (16.3) 0.755 0.385

Table 2

Comparison of disease activity and treatment status between overweight and obesity, as well as normal and reduced weight RA patients"

Items Total BMI＜25 kg/m2 BMI≥25 kg/m2 t/Z P
CRP/(mg/dL), M(IQR) 2.12 (5.77) 2.35 (6.53) 1.52 (3.61) -2.665 0.008
ESR/(mm/h), M(IQR) 43.0 (54.0) 50.0 (54.0) 34.0 (50.8) -2.953 0.003
TJC, M(IQR) 10.0 (17.0) 10.0 (16.0) 9.0 (18.0) -1.352 0.176
SJC, M(IQR) 5.0 (11.0) 5.5 (12.0) 4.0 (11.0) -1.521 0.128
VAS, $\bar x \pm s$ 4.18±2.93 4.40±2.85 3.66±3.08 2.551 0.011
DAS28, $\bar x \pm s$ 5.34±1.55 5.45±1.52 5.05±1.60 2.602 0.010
Bone erosion, n (%) 125 (33.1) 92 (35.2) 33 (28.2) 1.811 0.195
DMARDs, n (%) 453 (94.2) 320 (94.1) 133 (94.3) 0.008 0.929
NSAIDs, n (%) 170 (35.3) 120 (35.3) 50 (35.5) 0.001 0.972
GC, n (%) 226 (47) 157 (46.2) 69 (48.9) 0.305 0.581
Biologic agent, n (%) 31 (6.5) 21 (6.2) 10 (7.1) 0.133 0.716

Table 3

Comparison of extra-articular manifestations between overweight and obesity, as well as normal and reduced weight RA patients"

Total BMI＜25 kg/m2 BMI≥25 kg/m2 χ2 P
Rheumatoid vasculitis, n (%) 2 (0.4) 2 (0.6) 0 (0.0) 0.833 >0.999
Rheumatoid nodules, n (%) 28 (5.8) 21 (6.2) 7 (5.0) 0.267 0.605
Peripheral neuropathy, n (%) 9 (1.9) 8 (2.4) 1 (0.7) 1.467 0.294
Pericarditis, n (%) 10 (2.1) 7 (2.1) 3 (2.1) 0.002 1.000
Pleural effusion, n (%) 15 (3.1) 9 (2.6) 6 (4.3) 0.853 0.391
Interstitial lung disease, n (%) 103 (21.4) 72 (21.2) 31 (22.0) 0.039 0.844
Anemia, n (%) 240 (49.9) 189 (55.6) 51 (36.2) 15.032 < 0.001

Table 4

Comparison of laboratory examinations between overweight and obesity, as well as normal and reduced weight RA patients"

Items Total BMI＜25 kg/m2 BMI≥25 kg/m2 t/Z P
White blood cell /(109/L)，$\bar x \pm s$ 6.9±2.6 6.8±2.7 7.2±2.4 -1.349 0.178
Hemoglobin/(g/L), $\bar x \pm s$ 112.0±17.9 110.3±17.1 116.0±19.1 -3.158 0.002
Platelet/(109/L), M(IQR) 263 (141.5) 259 (146) 274 (128) -0.905 0.365
Total cholesterol/(mmol/L), $\bar x \pm s$ 4.3±1.0 4.2±1.0 4.5±1.1 -2.790 0.006
Triglyceride/(mmol/L), $\bar x \pm s$ 1.3±0.8 1.3±0.8 1.4±0.7 -1.839 0.067
Low-density lipoprotein cholesterol/(mmol/L), $\bar x \pm s$ 2.7±0.8 2.6±0.8 2.9±0.8 -2.879 0.004
High-density lipoprotein cholesterol/(mmol/L), $\bar x \pm s$ 1.1±0.3 1.1±0.3 1.1±0.4 -1.070 0.285
RF positive, n (%) 322 (66.9) 230 (67, 6) 92 (65.2) 0.259 0.611
Anti-CCP positive, n (%) 331 (68.8) 235 (69.1) 96 (68.1) 0.050 0.824

Table 5

Comparison of comorbidities between overweight and obesity, as well as normal and reduced weight RA patients"

Items Total BMI＜25 kg/m2 BMI≥25 kg/m2 χ2 P
Hypertension, n (%) 214 (44.5) 133 (39.1) 81 (57.4) 13.558 < 0.001
Diabetes mellitus, n (%) 87 (18.1) 51 (15.0) 36 (25.5) 7.462 0.006
Hyperlipidemia, n (%) 69 (14.3) 37 (10.9) 32 (22.7) 11.319 0.001
Fatty liver, n (%) 65 (13.5) 25 (7.4) 40 (28.4) 37.664 < 0.001
Coronary heart disease, n (%) 34 (7.1) 26 (7.6) 8 (5.7) 0.591 0.442
Cerebrovascular disease, n (%) 39 (8.1) 30 (8.8) 9 (6.4) 0.797 0.372
Peripheral atherosclerosis, n (%) 39 (8.1) 26 (7.6) 13 (9.2) 0.331 0.565
Osteoporosis, n (%) 325 (67.6) 241 (70.9) 84 (59.6) 5.816 0.016
Osteoarthritis, n (%) 155 (32.2) 100 (29.4) 55 (39.0) 4.202 0.040
Secondary Sjögren’s syndrome, n (%) 60 (12.5) 45 (13.2) 15 (10.6) 0.616 0.433
Venous thrombosis, n (%) 19 (4.0) 15 (4.4) 4 (2.8) 0.652 0.420

Table 6

Association between overweight and obesity and comorbidity outcomes"

Items Hypertensiona Diabetes mellitusb Hyperlipidemiac Fatty liverd Osteoporosise Osteoarthritisf Anemiaf
OR(95%CI) P OR(95%CI) P OR(95%CI) P OR(95%CI) P OR(95%CI) P OR(95%CI) P OR(95%CI) P
BMI < 25 kg/m2 References References References References References References References
BMI≥25 kg/m2 2.173
(1.398, 3.378)		 0.001 1.883
(1.108, 3.199)		 0.019 2.190
(1.270, 3.776)		 0.005 4.646
(2.605, 8.283)		 < 0.001 0.578
(0.373, 0.895)		 0.014 1.563
(1.018, 2.401)		 0.041 0.516
(0.333, 0.800)		 0.003
1 Emery P , Foster W , Suarez-Almazor M . Rheumatoid arthritis[J]. Clin Evid, 2002, (7): 1101- 1121.
2 Kitas GD , Erb N . Tackling ischaemic heart disease in rheumatoid arthritis[J]. Rheumatology, 2003, 42 (5): 607- 613.
doi: 10.1093/rheumatology/keg175
3 Metsios GS , Stavropoulos-Kalinoglou A , Panoulas VF , et al. New resting energy expenditure prediction equations for patients with rheumatoid arthritis[J]. Rheumatology, 2008, 47 (4): 500- 506.
4 Bray GA , Bellanger T . Epidemiology, trends, and morbidities of obesity and the metabolic syndrome[J]. Endocrine, 2006, 29 (1): 109- 117.
doi: 10.1385/ENDO:29:1:109
5 World Health Organisation . Obesity: Preventing and managing the global epidemic. Report of a WHO Consultation[J]. World Health Organ Tech Rep Ser, 2000, 894, 1- 253.
6 Adams KF , Schatzkin A , Harris TB , et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old[J]. N Engl J Med, 2006, 355 (8): 763- 778.
doi: 10.1056/NEJMoa055643
7 Elkan AC , Engvall IL , Cederholm T , et al. Rheumatoid cache-xia, central obesity and malnutrition in patients with low-active rheumatoid arthritis: Feasibility of anthropometry, mini nutritional assessment and body composition techniques[J]. Eur J Nutr, 2009, 48 (5): 315- 322.
doi: 10.1007/s00394-009-0017-y
8 Abuhelwa AY , Hopkins AM , Sorich MJ , et al. Association between obesity and remission in rheumatoid arthritis patients treated with diseasemodifying antirheumatic drugs[J]. Sci Rep, 2020, 10 (1): 18634.
doi: 10.1038/s41598-020-75673-7
9 Kremers HM , Crowson CS , Therneau TM , et al. High ten-year risk of cardiovascular disease in newly diagnosed rheumatoid arthritis patients: A population-based cohort study[J]. Arthritis Rheum, 2008, 58 (8): 2268- 2274.
doi: 10.1002/art.23650
10 Wolfe F , Michaud K . The risk of myocardial infarction and pharmacologic and nonpharmacologic myocardial nfarction predictors in rheumatoid arthritis: A cohort and nested case-control analysis[J]. Arthritis Rheum, 2008, 58 (9): 2612- 2621.
doi: 10.1002/art.23811
11 Escalante A , Haas RW , de Rincon I . Paradoxical effect of body mass index on survival in rheumatoid arthritis: Role of comorbidity and systemic inflammation[J]. Arch Intern Med, 2005, 165 (14): 1624- 1629.
doi: 10.1001/archinte.165.14.1624
12 Naranjo A , Sokka T , Descalzo MA , et al. Cardiovascular disease in patients with rheumatoid arthritis: Results from the QUEST-RA study[J]. Arthritis Res Ther, 2008, 10 (2): R30.
doi: 10.1186/ar2383
13 Stavropoulos-Kalinoglou A , Metsios GS , Koutedakis Y , et al. Redefining overweight and obesity in rheumatoid arthritis patients[J]. Ann Rheum Dis, 2007, 66 (10): 1316- 1321.
doi: 10.1136/ard.2006.060319
14 Alvarez-Nemegyei J , Pacheco-Pantoja E , González-Salazar M , et al. Association between overweight/obesity and clinical activity in rheumatoid arthritis[J]. Reumatol Clin, 2020, 16 (6): 462- 467.
doi: 10.1016/j.reuma.2018.11.005
15 Goossens J , Coustet B , Palazzo E , et al. Overweight and obesity affect clinical assessment of synovitis in rheumatoid arthritis: Comparison of ultrasonography and clinical exam[J]. Clin Exp Rheumatol, 2019, 37 (1): 49- 54.
16 常玲, 徐建华, 徐胜前, 等. 类风湿关节炎患者体质指数与疾病活动性的相关性研究[J]. 安徽医科大学学报, 2016, 51 (4): 544- 547.
17 Saravana S , Gillott T . Ischaemic heart disease in rheumatoid arthritis patients[J]. Rheumatology, 2004, 43 (1): 113- 114.
doi: 10.1093/rheumatology/keg433
18 George MD , ϕstergaard M , Conaghan PG , et al. Obesity and rates of clinical remission and low MRI inflammation in rheumatoid arthritis[J]. Ann Rheum Dis, 2017, 76 (10): 1743- 1746.
19 Ajeganova S , Andersson ML , Ingia LD , et al. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: A long-term followup from disease onset[J]. Arthritis Care Res (Hoboken), 2013, 65 (1): 78- 87.
20 Baker JF , England BR , Mikuls TR , et al. Obesity, weight loss, and progression of disability in rheumatoid arthritis[J]. Arthritis Care Res, 2018, 70 (12): 1740- 1747.
21 Nikiphorou E , Norton S , Young A , et al. The association of obesity with disease activity, functional ability and quality of life in early rheumatoid arthritis: Data from the early rheumatoid arthritis study/early rheumatoid arthritis network UK prospective cohorts[J]. Rheumatology (Oxford), 2018, 57 (7): 1194- 1202.
22 Mangnus L , Nieuwenhuis WP , van Steenbergen HW , et al. Body mass index and extent of MRI-detected inflammation: Opposite effects in rheumatoid arthritis versus other arthritides and asymptomatic persons[J]. Arthritis Res Ther, 2016, 18 (1): 245.
23 Stemmler F , Simon D , Liphardt AM , et al. Biomechanical pro-perties of bone are impaired in patients with ACPA-positive rheumatoid arthritis and associated with the occurrence of fractures[J]. Ann Rheum Dis, 2018, 77 (7): 973- 980.
24 Favalli EG . Understanding the role of interleukin-6 (IL-6) in the joint and beyond: A comprehensive review of IL-6 inhibition for the management of rheumatoid arthritis[J]. Rheumatol Ther, 2020, 7 (3): 473- 516.
[1] Xue ZOU,Xiao-juan BAI,Li-qing ZHANG. Effectiveness of tofacitinib combined with iguratimod in the treatment of difficult-to-treat moderate-to-severe rheumatoid arthritis [J]. Journal of Peking University (Health Sciences), 2023, 55(6): 1013-1021.
[2] Qi WU,Yue-ming CAI,Juan HE,Wen-di HUANG,Qing-wen WANG. Correlation between dyslipidemia and rheumatoid arthritis associated interstitial lung disease [J]. Journal of Peking University (Health Sciences), 2023, 55(6): 982-992.
[3] Yin-ji JIN,Lin SUN,Jin-xia ZHAO,Xiang-yuan LIU. Significance of IgA isotype of anti-v-raf murine sarcoma viral oncogene homologue B1 antibody in rheumatoid arthritis [J]. Journal of Peking University (Health Sciences), 2023, 55(4): 631-635.
[4] Rui LIU,Jin-xia ZHAO,Liang YAN. Clinical characteristics of patients with rheumatoid arthritis complicated with venous thrombosis of lower extremities [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1079-1085.
[5] Wen-xin CAI,Shi-cheng LI,Yi-ming LIU,Ru-yu LIANG,Jing LI,Jian-ping GUO,Fan-lei HU,Xiao-lin SUN,Chun LI,Xu LIU,Hua YE,Li-zong DENG,Ru LI,Zhan-guo LI. A cross-sectional study on the clinical phenotypes of rheumatoid arthritis [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1068-1073.
[6] Jing-feng ZHANG,Yin-ji JIN,Hui WEI,Zhong-qiang YAO,Jin-xia ZHAO. Cross-sectional study on quality of life and disease activity of rheumatoid arthritis patients [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1086-1093.
[7] Fang CHENG,Shao-ying YANG,Xing-xing FANG,Xuan WANG,Fu-tao ZHAO. Role of the CCL28-CCR10 pathway in monocyte migration in rheumatoid arthritis [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1074-1078.
[8] Yang-yang CHEN,Yu-bo ZHOU,Jing YANG,Yu-meng HUA,Peng-bo YUAN,Ai-ping LIU,Yuan WEI. Effects of gestational weight on the association between serum high sensitivity C reaction protein and gestational diabetes mellitus among twin gestations: A cohort study [J]. Journal of Peking University (Health Sciences), 2022, 54(3): 427-433.
[9] GAO Chao,CHEN Li-hong,WANG Li,YAO Hong,HUANG Xiao-wei,JIA Yu-bo,LIU Tian. Validation of the Pollard’s classification criteria (2010) for rheumatoid arthritis patients with fibromyalgia [J]. Journal of Peking University (Health Sciences), 2022, 54(2): 278-282.
[10] ZHONG Hua,XU Li-ling,BAI Ming-xin,SU Yin. Effect of chemokines CXCL9 and CXCL10 on bone erosion in patients with rheumatoid arthritis [J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1026-1031.
[11] ZHANG Lu,HU Xiao-hong,CHEN Cheng,CAI Yue-ming,WANG Qing-wen,ZHAO Jin-xia. Analysis of cervical instability and clinical characteristics in treatment-naive rheumatoid arthritis patients [J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1049-1054.
[12] LUO Liang,HUO Wen-gang,ZHANG Qin,LI Chun. Clinical characteristics and risk factors of rheumatoid arthritis with ulcerative keratitis [J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1032-1036.
[13] LOU Xue,LIAO Li,LI Xing-jun,WANG Nan,LIU Shuang,CUI Ruo-mei,XU Jian. Methylation status and expression of TWEAK gene promoter region in peripheral blood of patients with rheumatoid arthritis [J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1020-1025.
[14] Jian-mei ZOU,Li-jun WU,Cai-nan LUO,Ya-mei SHI,Xue WU. Relationship of serum 25- hydroxy vitamin D and systemic lupus erythematosus [J]. Journal of Peking University (Health Sciences), 2021, 53(5): 938-941.
[15] SHI Xin-ran,AN Mei-jing,CHEN Tian-jiao,Ma jun. Mediating effect of milk intake between family socioeconomic status and body mass index of children and adolescents [J]. Journal of Peking University (Health Sciences), 2021, 53(2): 308-313.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd