Evaluation of the impact of age and adiposity on a multi-biomarker disease activity score before and after adjustment
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ORIGINAL ARTICLE
Evaluation of the impact of age and adiposity on a multi-biomarker disease activity score before and after adjustment Joshua F. Baker 1,2,3 & Jeffrey R. Curtis 4 & David Chernoff 5 & Darl D. Flake II 5 & Eric Sasso 5 & Jin Long 6 & Elena Taratuta 7 & Michael D. George 2,3 Received: 30 October 2020 / Revised: 30 October 2020 / Accepted: 10 November 2020 # This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2020
Abstract Purpose We assessed the impact of adjustment of the multi-biomarker disease activity score (MBDA) for age, sex, and leptin, over the range of age and adiposity, and assessed relationships with clinical disease activity. Methods Patients with RA, ages 18–75 years, were recruited from clinical practices and completed whole-body DXA to quantify fat mass indices (FMI, kg/m2). FMI Z-scores were calculated based on distributions in a reference population. Descriptive statistics described relationships between age, FMI Z-score, and the original MBDA and adjusted MBDA (aMBDA). Swollen joint counts (SJC) and the clinical disease activity index (CDAI) were assessed over MBDA categories. Results There were 104 participants (50% female) with mean (SD) age of 56.1 (12.5) and body mass index (BMI) of 28.8 (6.9). Older age was associated with higher MBDA scores in men. The aMBDA was not associated with age. The original MBDA score was associated with FMI Z-score among women (Rho = 0.42, p = 0.002) but not men. The aMBDA was not associated with FMI Z-score in either women or men. The aMBDA score was lower than the original MBDA in the highest quartile of FMI in women and was higher in the lowest FMI quartiles in women and men. CDAI, SJC, and radiographic scores were similar across activity categories for the original MBDA score and aMBDA. Conclusions The aMBDA demonstrated reduced associations with adiposity, particularly among women. The aMBDA may be less likely to overestimate disease activity in women with greater adiposity and to underestimate disease activity in men and women with lesser adiposity. Key Points • Leptin adjustment of the MBDA score reduces the influence of adiposity, particularly among women. • Leptin adjustment results in significantly higher estimated disease activity in thin men and women. • The adjusted and unadjusted score correlate similarly with clinical disease activity measures.
Keywords Biomarkers . Disease activity . Obesity . Rheumatoid arthritis: Adiposity * Joshua F. Baker [email protected] 1
Philadelphia VA Medical Center, Philadelphia, PA, USA
2
University of Pennsylvania, Philadelphia, PA, USA
3
Department of Epidemiology and Biostatistics, University of Pennsylvania, 5th Floor White Building, 3600 Spruce Street, Philadelphia, PA 19104, USA
4
Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
5
Myriad Genetics and Laboratories, Salt Lake City, UT, USA
6
Stanford University, Palo Alto, CA, USA
7
Department of Radiology, Uni
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