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

   

PDF (PC)

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] Hui WEI, Jingfeng ZHANG, Zhongqiang YAO, Jinxia ZHAO. Clinical characteristics and relevant factors of rheumatoid arthritis patients with anemia of chronic disease [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 307-312.
[2] Hongyang LI, Tao HUANG, Linlin WANG. Total and regional fat-to-muscle mass ratio and risk of incident benign ovarian neoplasm [J]. Journal of Peking University (Health Sciences), 2026, 58(1): 169-174.
[3] Tao WU, Jianzi LIN, Yafeng ZHU, Jianda MA, Peiwen JIA, Lijuan YANG, jie PAN, Yaowei ZOU, Ying YANG, Ye LU, Lie DAI. Serum inter-alpha-trypsin inhibitor heavy chain H3 is identified as a potential biomarker for myopenia in patients with rheumatoid arthritis using proteomic profiling [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1024-1031.
[4] Yan DING, Lifang WANG, Chaoran LI, Zhemin LU, Lianjie SHI. Rheumatoid arthritis combined with IgG4-related disease successfully treated with rituximab: A case report [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1203-1207.
[5] Ju YANG, Jing XU, Juhua DAI, Lianjie SHI. Expression of lumican protein in serum of patients with rheumatoid arthritis and its correlation with disease and immune activities [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 911-918.
[6] Lianghua FENG, Lirong HONG, Yujia CHEN, Xueming CAI. Role and mechanism of ubiquitin-specific protease 35 in ferroptosis of rheumatoid arthritis-fibroblast like synoviocytes [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 919-925.
[7] Kun WANG, Huairong WANG, Huan YU, Ruotong YANG, Liuyan ZHENG, Jingxian WU, Xueying QIN, Tao WU, Dafang CHEN, Yiqun WU, Yonghua HU. Identifying genetic etiology of ischemic stroke based on pleiotropy of obesity related genes: A sibling study [J]. Journal of Peking University (Health Sciences), 2025, 57(3): 448-455.
[8] Peiwen JIA, Ying YANG, Yaowei ZOU, Zhiming OUYANG, Jianzi LIN, Jianda MA, Kuimin YANG, Lie DAI. Clinical characteristics of overlapping syndromes of low muscle mass in patients with rheumatoid arthritis and their impact on physical function [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1009-1016.
[9] Hongyan WANG, Xinming LI, Kechi FANG, Huaqun ZHU, Rulin JIA, Jing WANG. Analysis of characteristics related to the disease activity of systemic lupus erythematosus and construction of an evaluation model [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1017-1022.
[10] Doudou MA, Zhemin LU, Qian GUO, Sha ZHU, Jin GU, Yan DING, Lianjie SHI. Successful treatment of rheumatoid arthritis complicated with myasthenia gravis with low-dose rituximab: A case report [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1110-1114.
[11] Rui YAN, Dan KE, Yan ZHANG, Li LI, Huanran SU, Wei CHEN, Mingxia SUN, Xiaomin LIU, Liang LUO. Diagnostic significance of serum chemokine CXCL-10 and Krebs von den lungen-6 level in patients with rheumatoid arthritis associated interstitial lung disease [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 956-962.
[12] Liang ZHAO, Chenglong SHI, Ke MA, Jing ZHAO, Xiao WANG, Xiaoyan XING, Wanxing MO, Yirui LIAN, Chao GAO, Yuhui LI. Immunological characteristics of patients with anti-synthetase syndrome overlap with rheumatoid arthritis [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 972-979.
[13] Jiayu ZHAI, Jinxia ZHAO, Zhuo AN, Rui LIU. Assessment of residual symptoms in patients with axial spondyloarthritis with low disease activity and analysis of its related factors [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 987-993.
[14] Yijun HAN, Xiaoli CHEN, Changhong LI, Jinxia ZHAO. Application status of methotrexate in patients with rheumatoid arthritis [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 994-1000.
[15] Dongwu LIU, Jie CHEN, Mingli GAO, Jing YU. Rheumatoid arthritis with Castleman-like histopathology in lymph nodes: A case report [J]. Journal of Peking University (Health Sciences), 2024, 56(5): 928-931.
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