Prevalence of obesity in rheumatoid arthritis and its association with disease activity and latex positivity in a sample of patients in Erbil
Background and objective: The prevalence of obesity is rising across the world and it is regarded as a major health concern which is thought to be associated with a number of chronic illnesses including rheumatoid arthritis. This study aimed to find out the prevalence of obesity in patients with rheumatoid arthritis and to apprehend the association of obesity with disease activity and latex positivity.
Methods: One hundred twenty patients with rheumatoid arthritis who were regularly visiting Rizgary Teaching Hospital in Erbil were included in a cross-sectional study using specially designed mixed questionnaire. Body mass index and waist circumferences were measured, and their association with disease activity score 28 (DAS28) and clinical disease activity index (CDAI) were estimated. Furthermore, we evaluated their association with positive latex test.
Results: There was increased frequency of obesity in rheumatoid arthritis patients, and there was a positive association between body mass index and waist circumference with disease activity measured by DAS28 and CDAI (P <0.001). There was no significant association between obesity and latex positivity which has been assessed separately for males and females (P = 0.898 and 0.086, respectively).
Conclusion: Obesity is frequently found in rheumatoid arthritis patients. It is associated with higher disease activity, but not with the latex positivity in these patients.
Harris ED. Clinical features of rheumatoid arthritis. In: Kelley’s Textbook of Rheumatology. 7th ed. W.B. Saunders: Philadelphia, PA; 2005. PP. 1043–78.
Shah A. Harrison's Principle of Internal Medicine. 18th ed. United States: McGraw Hill; 2012.P. 2738.
Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet 2010; 376 (9746): 1094–108.
Doherty M, Lanyon P, Ralston SH. Musculosketal Disorders-Davidson's Principle of Internal Medicine. 20th ed. Edinburgh: Churchill Livingstone Elsevier; 2006. PP. 1100–6.
Plenge RM, Seielstad M, Padyukov L, Lee AT, Remmers EF, Ding B ,et al. TRAF1-C5 as a Risk Locus for Rheumatoid Arthritis — A Genomewide Study. N Engl J Med. 2007; 357 (12): 1199–209.
Erhardt CC, Mumford PA, Venables PJ, Maini RN, Factors predicting a poor life prognosis in rheumatoid arthritis: an eight year prospective study. Ann Rheum Dis 1989;48:7-13.
Kitas GD, Erb N. Tackling ischaemic heart disease in rheumatoid arthritis. Rheumatology 2003;42:607-13.
Gonzalez-Gay MA, Gonzalez-Juanatey C, Lopez-Diaz MJ, Carlos GP, Jose AM. HLA-DRB1 and persistent chronic inflammation contribute to cardiovascular events and cardiovascular mortality in patients with rheumatoid arthritis. Arthritis Rheum2007; 57:125-32.
Panoulas VF, Nikas SN, Smith JP, Douglas KM, Nightingale P, Millionis HJ. Lymphotoxin 252A>G polymorphism is common and associates with myocardial infarction in patients with rheumatoid arthritis. Ann Rheum Dis 2008; 67:1550-6.
Panoulas VF, StavropoulosKalinoglou A, Metsios GS, Giorgos SM. Association of interleukin-6 (IL-6)-174G/C gene polymorphism with cardiovascular disease in patients with rheumatoid arthritis: the role of obesity and smoking. Atherosclerosis 2009; 204:178-83.
Mattey DL, Dawes PT, Nixon NB, Goh L, Banks MJ, Kitas GD. Increased levels of antibodies to cytokeratin 18 in patients with rheumatoid arthritis and ischaemic heart disease. Ann Rheum Dis 2004; 63:420-5.
Panoulas VF, Douglas KM, Milionis HJ, Nightingale P, Stavropoulos-Kalinogou A. Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis. Rheumatology2007; 46:1477-82.
Toms TE, Panoulas VF, Douglas KM, Griffiths HR, Kitas GD. Lack of association between glucocorticoid use and presence of the metabolic syndrome in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther2008;10: R145.
Stevens RJ, Douglas KM, Saratzis AN, Kitas GD. Inflammation and atherosclerosis in rheumatoid arthritis. Expert Rev Mol Med 2005; 7:1-24.
Gonzalez A, Kremers HM, Crowson CS, Ballman KV, Roger VL. Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in non-rheumatoid arthritis patients? Ann Rheum Dis 2008; 67:64-9.
Stavropoulos-Kalinoglou A, Metsios GS, Koutedakis Y, Kitas GD. Obesity in rheumatoid arthritis, Rheumatology 2011;50:450–62.
Metsios GS, StavropoulosKalinoglou A, Panoulas VF, Koutedakis Y. New resting energy expenditure prediction equations for patients with rheumatoid arthritis. Rheumatology 2008;47: 500-6.
Roubenoff R, Roubenoff RA, Cannon JG, Josef JK. Rheumatoid cachexia: cytokine-driven hypermetabolism accompanying reduced body cell mass in chronic inflammation. J Clin Invest 1994; 93:2379-86.
StavropoulosKalinoglou A, Metsios GS, Koutedakis Y, Nevill AM, Douglas KM, Jamurtas A, et al. Redefining overweight and obesity in rheumatoid arthritis patients. Ann Rheum Dis2007; 66:1316-21.
Mohamed-Ali V, Pinkney JH, Coppack SW. Adipose tissue as an endocrine and paracrine organ. Int J Obes Relat Metab Disord 1998; 22:1145-58.
Houseknecht KL, Baile CA, Matteri RL, Spurlock ME. The biology of leptin: a review. J Anim Sci 1998; 76:1405-20.
Chandran M, Phillips SA, Ciaraldi T, Henry RR. Adiponectin: more than just another fat cell hormone? Diabetes Care 2003; 26:2442-50.
Ramos EJB, Xu Y, Romanova I, Irina R, Middleton F. Is obesity an inflammatory disease? Surgery 2003; 134:329-35.
Pincus T, Furer V, Keystone E, Yazici Y, Bergman MJ, Luijtens K. RAPID3 (Routine Assessment of Patient Index Data 3) severity categories and response criteria: Similar results to DAS28 (Disease Activity Score) and CDAI (Clinical Disease Activity Index) in the RAPID 1 (Rheumatoid Arthritis Prevention of Structural Damage) clinical trial of certolizumab pegol, Arthritis Care and Research 2011; 63:1142-9.
Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ,et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet2011;377:557–67.
Axel Finckh, Carl Turesson. The impact of obesity on the development and progression of rheumatoid arthritis, Ann Rheum Dis 2014; 73(11): 1911-3.
Klaasen R, Wijbrandts CA, Gerlag DM, Tak PP. Body Mass Index and Clinical Response to Infliximab in Rheumatoid Arthritis, Arthritis and Rheumatism 2011; 63(2): 359-64.
Crowson CS, Matteson EL, Davis JM, Gabriel SE. Contribution of obesity to the rise in incidence of rheumatoid arthritis. Arthritis Care Res (Hoboken) 2013;65:71–7.
Giles J, Ling S, Ferruci L, Bartlett S, Andersen R, Towns M, et al. Abnormal body composition phenotypes in older Rheumatoid Arthritis patients: association with disease characteristics and pharmacotherapies. Arthritis Care Res 2008; 59:807-15.
Armstrong D, McCausland E, Quinn A, Wright G. Obesity and cardiovascular risk factors in rheumatoid arthritis. Rheumatology 2006; 45:782.
Vidal C, Barnetche T, Morel J, Combe B, Daïen C. Influence of body mass index on disease activity and radiographic joint damage in rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Rheumatol 2014;66 (11 Suppl):S167.
Jawaheer D, Olsen J, Lahiff M, Forsberg S, Lähteenmäki J, da Silveira IG , et al. Gender, body mass index and rheumatoid arthritis disease activity: results from the QUEST-RA Study. Clin Exp Rheumatol 2010;28:454–61.
Daïen CI, Sellam J. Obesity and inflammatory arthritis: impact on occurrence, disease characteristics and therapeutic response RMD open 2015. 1(1), e000012.
Ajeganova S, Andersson ML, Hafström I. BARFOT Study Group. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: a long-term followup from disease onset. Arthritis Care Res 2013;65:78–87.
Baker JF, George M, Baker DG, Toedter G, Von Feldt JM, Leonard MB. Associations between body mass, radiographic joint damage, adipokines and risk factors for bone loss in rheumatoid arthritis. Rheumatol Oxf Engl 2011;50: 2100–7.
Heimans L, van den Broek M, le Cessie S, Siegerink B, Riyazi N, Han KH, et al. Association of high body mass index with decreased treatment response to combination therapy in recent-onset rheumatoid arthritis patients. Arthritis Care Res 2013;65:1235–42.
Van der Helm-van Mil AH, van der Kooij SM, Allaart CF, Toes RE, Huizinga TW. A high body mass index has a protective effect on the amount of joint destruction in small joints in early rheumatoid arthritis. Ann Rheum Dis 2008;67:769–74.
Pedersen M, Jacobsen S, Klarlund M, Pedersen B V, Wiik A, Wohlfahrt J, et al. Environmental risk factors differ between rheumatoid arthritis with and without auto-antibodies against cyclic citrullinated peptides. Arthritis Res Ther 2006;8:R133.
Wesley A, Bengtsson C, Elkan AC, Klareskog L, Alfredsson L, Wedren S, et al. Association between body mass index and anti-citrullinated protein antibody-positive and anti-citrullinated protein antibody-negative rheumatoid arthritis: results from a population-based case-control study. Arthritis Care Res (Hoboken) 2013;65: 107–12.
Lahiri M, Luben RN, Morgan C, Bunn DK, Marshall T, Lunt M, et al. Using lifestyle factors to identify individuals at higher risk of inflammatory polyarthritis (results from the European Prospective Investigation of Cancer-Norfolk and the Norfolk Arthritis Register—the EPIC-2-NOAR Study). Ann Rheum Dis 2014;73:219–6.
Lu B, Hiraki L, Sparks JA, Malspeis S, Chen CY, Awosogba JA, et al. Being overweight or obese and risk of developing rheumatoid arthritis among women: a prospective cohort study. Ann Rheum Dis2014;73:1914–22.
Westhoff G, Rau R, Zink A. Radiographic joint damage in early rheumatoid arthritis is highly dependent on body mass index. Arthritis Rheum 2007;56:3575–82.
Baker JF, Ostergaard M, George M, Shults J, Emery P, Baker DG ,et al. Greater body mass independently predicts less radiographic progression on X-ray and MRI over 1–2years. Ann Rheum Dis2014;73:1923–8.
Stavropoulos-Kalinoglou A, Metsios GS, Smith JP, Panoulas VF, Douglas KMJ, Jamurtas AZ, et al. What predicts obesity in patients with rheumatoid arthritis? An investigation of the interactions between lifestyle and inflammation. Int J Obes 2010;34: 295–301.
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