Catholic University of the Sacred Heart, Rome, Italy.
Arthritis Care Res (Hoboken). 2013 Jan;65(1):94-100. doi: 10.1002/acr.21768.
Obesity is a mild, long-lasting inflammatory disease and, as such, could increase the inflammatory burden of rheumatoid arthritis (RA). The study aim was to determine whether obesity represents a risk factor for a poor remission rate in RA patients requiring anti-tumor necrosis factor α (anti-TNFα) therapy for progressive and active disease despite treatment with methotrexate or other disease-modifying antirheumatic drugs.
Patients were identified from 15 outpatient clinics of university hospitals and hospitals in Italy taking part in the Gruppo Italiano di Studio sulle Early Arthritis network. Disease Activity Score in 28 joints (DAS28), body mass index (BMI; categorized as <25, 25-30, and >30 kg/m(2) ), acute-phase reactants, IgM rheumatoid factor, and anti-cyclic citrullinated peptide antibody values were collected. DAS28 remission was defined as a score of <2.6 lasting for at least 3 months.
Six hundred forty-one outpatients with longstanding RA receiving anti-TNFα blockers (adalimumab, n = 260; etanercept, n = 227; infliximab, n = 154), recruited from 2006-2009 and monitored for at least 12 months, were analyzed. The mean ± SD DAS28 at baseline was 5.6 ± 1.4. A BMI of >30 kg/m(2) was recorded in 66 (10.3%) of 641 RA patients. After 12 months of anti-TNFα treatment, a DAS28 of <2.6 was noted in 15.2% of the obese subjects, in 30.4% of the patients with a BMI of 25-30 kg/m(2) , and in 32.9% of the patients with a BMI of <25 kg/m(2) (P = 0.01). The lowest percentage of remission, which was statistically significant versus adalimumab and etanercept (P = 0.003), was observed with infliximab.
Obesity represents a risk factor for a poor remission rate in patients with longstanding RA treated with anti-TNFα agents. A personalized treatment plan might be a possible solution.
肥胖是一种轻度、持久的炎症性疾病，因此可能会增加类风湿关节炎（RA）的炎症负担。本研究旨在确定肥胖是否是接受肿瘤坏死因子-α（抗 TNFα）治疗的 RA 患者在接受甲氨蝶呤或其他改善病情抗风湿药物治疗后，疾病仍持续进展和活动的情况下，其缓解率较差的一个危险因素。
从意大利的 15 家大学医院和医院的早期关节炎网络的意大利研究小组（Gruppo Italiano di Studio sulle Early Arthritis network）的门诊患者中确定研究对象。收集疾病活动评分 28 关节（DAS28）、体重指数（BMI；分为 <25、25-30 和 >30 kg/m²）、急性期反应物、IgM 类风湿因子和抗环瓜氨酸肽抗体值。DAS28 缓解定义为至少持续 3 个月的评分 <2.6。
2006 年至 2009 年间共招募了 641 名接受抗 TNFα 阻滞剂（阿达木单抗，n=260；依那西普，n=227；英夫利昔单抗，n=154）治疗的长期 RA 门诊患者，对其进行了至少 12 个月的监测。641 例 RA 患者的平均基线 DAS28 ± SD 为 5.6 ± 1.4。641 例 RA 患者中有 66 例（10.3%）记录到 BMI >30 kg/m²。在接受抗 TNFα 治疗 12 个月后，肥胖患者中有 15.2%、BMI 为 25-30 kg/m²的患者中有 30.4%、BMI <25 kg/m²的患者中有 32.9%（P=0.01）达到 DAS28 <2.6。与阿达木单抗和依那西普相比，接受英夫利昔单抗治疗的患者缓解率最低（P=0.003），且差异有统计学意义。
肥胖是接受抗 TNFα 药物治疗的长期 RA 患者缓解率较差的一个危险因素。可能需要制定个体化的治疗方案。
