The Impact of Obesity on Disease Activity and Treatment Response in Rheumatoid Arthritis
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RHEUMATOID ARTHRITIS (L MORELAND, SECTION EDITOR)
The Impact of Obesity on Disease Activity and Treatment Response in Rheumatoid Arthritis Dilli Poudel 1
&
Michael D. George 1,2
&
Joshua F. Baker 1,2,3,4
# This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Abstract Purpose of the Review A growing number of studies have suggested that disease outcomes and response to therapy may be different in patients with rheumatoid arthritis (RA) who are obese. The goal of this review is to examine the most recent literature, with a focus on the impact of obesity on the assessment of disease activity and treatment outcomes in RA. Recent Findings Obesity is common in patients with RA and can have a substantial impact on patient symptoms and outcomes. Obesity is associated with higher rates of chronic pain and opiate use, elevated inflammatory markers, and less reliable physical exam findings, making assessment of disease activity and treatment response more challenging. Despite seemingly worse clinical disease activity, evidence has accumulated demonstrating that obese patients with RA have less inflammation by imaging and lower rates of radiographic progression over time. Whether obesity influences the effectiveness of specific therapies remains controversial. Summary Obesity is very common and is associated with more severe symptoms and higher rates of disability among RA patients. While clinical disease activity is frequently observed to be higher in obese patients with RA, it remains unclear whether poorer treatment response rates in this setting are related to reduced efficacy of therapies or are an artifact of biases in the accurate assessment of the disease. Keywords Rheumatoid arthritis . Obesity . Adiposity . Body mass index
Introduction Obesity is arguably the most worrying current public health crisis because it is both extremely common and leads to numerous adverse health outcomes. It is not, therefore, surprising that obesity has important implications for rheumatoid arthritis (RA) and its management. This article is part of the Topical Collection on Rheumatoid Arthritis * Joshua F. Baker [email protected] 1
Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
2
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
3
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
4
Division of Rheumatology, Department of Medicine, Hospital of the University of Pennsylvania, 5 White Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
Obesity is an inflammatory state, with excess visceral adiposity being associated with elevation in systemic cytokines, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) [1•, 2]. This observation has led to the hypothesis that obesity may drive and contribute to the development and perpetuation of systemic inflammatory conditions including inflammatory arthritis. In support of thi
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