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Being overweight linked to significantly higher disease severity in psoriatic arthritis

June 12, 2019

Annual European Congress of Rheumatology (EULAR 2019)
Madrid, Spain, 12-15 June 2019

Madrid, Spain, 12 June 2019: The results of a study presented today at the Annual European Congress of Rheumatology (EULAR 2019) demonstrate significant correlation between body mass index (BMI) and disease severity in psoriatic arthritis.1

Psoriatic arthritis is a chronic inflammatory disease that affects the skin and joints, causing pain and disability. The disease often causes swelling of the fingers and toes, mainly because of joint inflammation. Although psoriatic arthritis has been associated with an enhanced prevalence of obesity and being overweight, few studies have assessed the relationship between weight and the severity of disease in these patients.

Results of this study demonstrate BMI is independently correlated to disease activity (p=0.026), patient-perceived disease impact (p<0.0001), and disability (p<0.0001). In patients with PsA classified as obese or non-obese, disease activity measure cDAPSA (range 0-154) was 33.4 vs. 27.7, patient-perceived disease impact measure PsAID-12* (range 0-10) was 6.3 vs. 5.3, and disability measure HAQ-DI* (range 0-3) was 1.36 vs. 1.03 respectively.1

"Our results highlight the impact of obesity and need for lifestyle-directed approaches to manage weight in psoriatic arthritis in parallel to joint and skin focused treatments," said Dr Stefan Siebert, Clinical Senior Lecturer in Inflammation and Rheumatology, University of Glasgow, United Kingdom.

The study included 917 patients across eight European countries as part of the PsABio study, an ongoing prospective observational study evaluating patients with PsA receiving ustekinumab or tumour necrosis factor inhibitors. Data were collected on disease severity and impact, and analysed using multiple regression models adjusted for age, sex, smoking, body surface area, c-reactive protein, disease duration and biologic treatment.1

"There is growing evidence describing how fat tissue acts as an active organ involved in metabolic and inflammatory disorders," said Professor John D. Isaacs, Chairperson of the Abstract Selection Committee, EULAR. "Furthermore, with fixed-dose drug regimens, as with self-injected biologics, obesity can reduce efficacy for pharmacokinetic reasons." These factors, alongside the global epidemic of overweight and obesity, makes research in this area of great relevance and interest."

Another study presented today at EULAR 2019 provides evidence for the adipokine, adiponectin, in predicting the development of rheumatoid arthritis in overweight subjects.

Adipokines are signalling molecules that are secreted by fat tissue and act in a similar way to hormones. Raised levels of adiponectin, a type of adipokine, have been shown in subjects with rheumatoid arthritis, however, results of this study suggest it could have a role in predicting the onset of disease.4

"Early detection and management of rheumatoid arthritis is very important to improve disease outcomes in patients," said Cristina Maglio, MD, PhD, University of Gothenburg, Gothenburg, Sweden. "Our analysis suggests that serum adiponectin in overweight patients might have a role as a biomarker for early rheumatoid arthritis."

The analysis included two studies, the first included 82 subjects with obesity and available measurements of adiponectin before the development of rheumatoid arthritis and 410 matched controls and demonstrated a 10% increased risk of developing rheumatoid arthritis in those with raised serum adiponectin at baseline. The second study included 88 sex- and age-matched pairs and demonstrated a 20% increased risk, but only in those with a BMI greater than 25.4

Finally, another interesting study presented today at EULAR 2019, looked at overweight and obesity in young patients with juvenile idiopathic arthritis (JIA).

Results found the rate of being overweight, and obesity in children and adolescents with JIA is comparative to the general population. However, further analysis revealed a number of factors are significantly associated with being overweight in the JIA group including increasing age (OR:1.06, 95% CI:1.04-1.09), male gender (OR:1.21, 95% CI:1.04-1.44), functional limitations (OR:1.29, 95% CI:1.04-1.59), therapy with biological DMARDs (OR:1.48, 95% CI:1.22-1.80), and systemic glucocorticoids (OR:1.40, 95% CI:1.14-1.71). The implications of these findings on the long-term outcome of JIA requires further study.

Abstract numbers: OP0007, THU0061, OP0259
-end-
NOTES TO EDITORS

For further information on this study, or to request an interview with the study lead, please do not hesitate to contact the EULAR Press Office:

Email: eularpressoffice@ruderfinn.co.uk
Telephone: +44 (0) 20 7438 3084
Twitter: @EULAR_Press
EULAR TV: YouTube.com/EULARorg

About Rheumatic and Musculoskeletal Diseases

Rheumatic and musculoskeletal diseases (RMDs) are a diverse group of diseases that commonly affect the joints, but can also affect the muscles, other tissues and internal organs. There are more than 200 different RMDs, affecting both children and adults. They are usually caused by problems of the immune system, inflammation, infections or gradual deterioration of joints, muscle and bones. Many of these diseases are long term and worsen over time. They are typically painful and Iimit function. In severe cases, RMDs can result in significant disability, having a major impact on both quality of life and life expectancy.

About EULAR

The European League against Rheumatism (EULAR) is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with RMDs. EULAR aims to reduce the burden of RMDs on individuals and society and to improve the treatment, prevention and rehabilitation of RMDs. To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with RMDs by the EU institutions through advocacy action.

To find out more about the activities of EULAR, visit: http://www.eular.org

References
    1. Siebert S, Bergmans P, de Vlam K, et al. High body mass index (BMI) in psoriatic arthritis (PsA) is associated with higher disease activity in joints and skin, impaired quality of life and more disability: results from the PsABio study. EULAR 2019; Madrid: Abstract OP0007.

    2. Gremese E, Tolusso B, Gigante MR, et al. Obesity as a risk and severity factor in rheumatic diseases (autoimmune chronic inflammatory diseases). Front Immunol. 2014;5:576.

    3. Gossec L, Athanassiou P, Bergmans P, et al. SAT0337: Biologic DMARDs and psoriatic arthritis in Europe in 2016/2017: characteristics of patients starting TNF-inhibitors or ustekinumab in the ongoing PsABio observational cohort study. Ann Rheum Dis. 2018;77(suppl2):1033.

    4. Milatz F, Klotsche J, Niewerth M, et al. In overweight subjects, serum adiponectin predicts the development of rheumatoid arthritis independently of other adipokines. EULAR 2019; Madrid: Abstract THU0061.

    5. Otero M, Lago R, Gomez R, et al. Changes in plasma levels of fat-derived hormones adiponectin, leptin, resistin and visfatin in patients with rheumatoid arthritis. Ann Rheum Dis. 2006;65(9):1198-201.

    6. Milatz F, Klotsche J, Niewerth M, et al. Overweight and obesity in patients with juvenile idiopathic arthritis enrolled in the German National Paediatric Rheumatologic Database (NPRD). EULAR 2019; Madrid: Abstract OP0259.

    7. van der Heijde D, Daikh DI, Betteridge N, et al. Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers and other stakeholders endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). Ann Rheum Dis. 2018 Jun;77(6):829-832.

    European League Against Rheumatism

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