Weight loss, disease activity, and patient reported outcomes in patients with musculoskeletal and autoimmune diseases taking weight loss medications: a retrospective cohort study

Abstract

Introduction: Given potential impacts of adiposity on pain and inflammation, we evaluated if weight loss was associated with improvements in disease activity and patient reported outcomes (PROs) in people with rheumatic and musculoskeletal disease (RMD) using weight loss therapies.

Methods: Participants with RMDs enrolled in the FORWARD Databank and reporting weight loss medication use were included in this retrospective cohort study. Linear models using generalized estimating equations assessed the association with ≥5 % weight loss and changes in PROs and disease activity over a 6-month period, clustering by participant and adjusting for the prior 6-month PRO, BMI, diabetes status, age, and sex. Testing for effect modification was performed to assess whether the effect of weight loss varied across BMI categories and across condition.

Results: We identified 3868 users of weight loss medications with 24,484 discrete observations. Weight loss ≥5 % was reported in 10.5 % (2603) of observations and was associated with improvements in patient activity scale II (PAS-II), patient global assessment, pain, fatigue, polysymptomatic distress, and SF-36 physical component score (PAS-II adjusted: B -0.12, 95 % CI -0.17, -0.067, p < 0.001). Those who lost ≥5 % of weight were more likely to have improvements in PAS-II and PROs if they were obese, independent of diagnosis.

Conclusion: Among participants with RMDs that reported weight loss medication use, ≥5 % weight loss was associated with statistically significant improvements in patient-reported disease activity and quality of life PROs. The use of weight loss medications could be considered in trials aimed at improving symptoms of RMDs.

Keywords: Cohort study; Disease activity; Patient-reported outcomes; Weight loss.

Figure 1.

Cohort diagram depicting cohort attrition by application of inclusion/exclusion criteria and data availability.

Figure 2.

Association of 5% weight loss with disease activity and PROs. Regression models assessing the association between a ≥5% weight loss and a change in PROs demonstrate statistically significant improvement in global severity, pain, fatigue, short form physical component score, patient activity scale, and polysymptomatic distress in those with ≥5% weight loss. Analysis used generalized linear model using a generalized estimating equation clustered by participant, adjusted for the prior 6-month PRO, BMI category, diagnosis of diabetes, age, and sex. Tabulated values show the effect from generalized linear model with 95% confidence interval and p-value for this effect size coefficient. Graph shows standardized effect sizes for PROs, derived by dividing the effect size by the standard deviation; negative values indicate improvement in scores in participants ≥5% weight loss.

Figure 3.

Association of ≥5% change in weight and the Patient Activity Scale-II (PAS-II), across subgroups. A) The PAS-II was significantly lower in the total cohort and among those with psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), osteoarthritis (OA), and fibromyalgia (FM), but not in those with rheumatoid arthritis (RA). B) Participants who were obese had reductions in their PAS-II with ≥5% weight loss, but those who were of healthy weight had worsened disease activity associated with ≥5% weight loss. C) Participants who were obese and one of the conditions were more likely to report improvement in PAS-II associated with ≥5% weight loss.