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Observational Study
. 2017 Dec;69(12):1789-1798.
doi: 10.1002/acr.23229. Epub 2017 Nov 6.

Impact of Obesity and Adiposity on Inflammatory Markers in Patients With Rheumatoid Arthritis

Michael D George  1 , Jon T Giles  2 , Patricia P Katz  3 , Bryant R England  4 , Ted R Mikuls  4 , Kaleb Michaud  4 , Alexis R Ogdie-Beatty  5 , Said Ibrahim  6 , Grant W Cannon  7 , Liron Caplan  8 , Brian C Sauer  9 , Joshua F Baker  6
Affiliations
Observational Study

Impact of Obesity and Adiposity on Inflammatory Markers in Patients With Rheumatoid Arthritis

Michael D George et al. Arthritis Care Res (Hoboken). 2017 Dec.

Abstract

Objective: The C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) are important disease activity biomarkers in rheumatoid arthritis (RA). This study aimed to determine to what extent obesity biases these biomarkers.

Methods: Body mass index (BMI) associations with CRP level and ESR were assessed in 2 RA cohorts: the cross-sectional Body Composition (BC) cohort (n = 451), including whole-body dual x-ray absorptiometry measures of fat mass index; and the longitudinal Veterans Affairs Rheumatoid Arthritis (VARA) registry (n = 1,652), using multivariable models stratified by sex. For comparison, associations were evaluated in the general population using the National Health and Nutrition Examination Survey.

Results: Among women with RA and in the general population, greater BMI was associated with greater CRP levels, especially among women with severe obesity (P < 0.001 for BMI ≥35 kg/m2 versus 20-25 kg/m2 ). This association remained after adjustment for joint counts and patient global health scores (P < 0.001 in BC and P < 0.01 in VARA), but was attenuated after adjustment for fat mass index (P = 0.17). Positive associations between BMI and ESR in women were more modest. In men with RA, lower BMI was associated with higher CRP levels and ESR, contrasting with positive associations among men in the general population.

Conclusion: Obesity is associated with higher CRP levels and ESR in women with RA. This association is related to fat mass and not RA disease activity. Low BMI is associated with higher CRP levels in men with RA; this unexpected finding remains incompletely explained but likely is not a direct effect of adiposity.

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Figures

Figure 1
Figure 1. Predicted CRP in men and women by BMI category in patients with rheumatoid arthritis (VARA and BC) and the general population (NHANES 2007–2010)
CRP predicted from linear regression models or GEE models (in VARA) of CRP at the means of age, race, smoking status. BMI: body mass index; VARA: Veteran’s Affairs Rheumatoid Arthritis Registry; BC: 3 pooled body composition studies of rheumatoid arthritis patients. NHANES: National Health and Nutrition Examination Survey 2007–2010. * p < 0.05, ** p < 0.01, *** p < 0.001 vs. reference range BMI 20–25 kg/m2 category within each cohort.
Figure 2
Figure 2. Predicted ESR in men and women by BMI category in patients with rheumatoid arthritis (VARA and BC) and the general population (NHANES I)
ESR predicted from linear regression models or GEE models (in VARA) of ln(ESR) at the means of age, race. VARA and BC also adjusted for smoking. BMI: body mass index; VARA: Veteran’s Affairs Rheumatoid Arthritis Registry; BC: 3 pooled body composition studies of rheumatoid arthritis patients. NHANES I: National Health and Nutrition Examination Survey 1971–1974. * p < 0.05, ** p < 0.01, *** p < 0.001 vs. reference range BMI 20–25 kg/m2 category within each cohort.
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References

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