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

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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)

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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
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