Leiden University Medical Center, Leiden, The Netherlands.
Arthritis Care Res (Hoboken). 2013 Aug;65(8):1235-42. doi: 10.1002/acr.21978.
To assess the association between high body mass index (BMI) and treatment response in recent-onset rheumatoid arthritis.
In the Behandelstrategieën voor Reumatoide Artritis (Treatment Strategies for Rheumatoid Arthritis) study, 508 patients were randomized to initial monotherapy or combination therapy with prednisone or infliximab (IFX). The response to Disease Activity Score (DAS) ≤2.4-steered treatment (first dose and after 1 year) was compared between patients with a BMI <25 kg/m(2) and ≥25 kg/m(2) , using relative risk (RR) regression analyses. DAS, components of DAS, and functional ability during the first year were compared using linear mixed models.
High BMI was independently associated with failure to achieve a DAS ≤2.4 on initial therapy (RR 1.20 [95% confidence interval (95% CI) 1.05, 1.37]). The effect for combination therapy with prednisone was RR 1.55 (95% CI 1.06, 2.28) and for combination therapy with IFX 1.42 (95% CI 0.98, 2.06). The RRs for failure after 1 year were 1.46 (95% CI 0.75, 2.83) and 2.20 (95% CI 0.99, 4.92), respectively. High BMI was also associated with failure on delayed combination therapy with IFX, after adjustment for selection bias related to previous failure on disease-modifying antirheumatic drugs. No significant association was observed in the initial monotherapy groups. In the first year, patients with a high BMI had higher DAS and worse functional ability, with more tender joints and a higher visual analog scale global health, but not more swollen joints and similar systemic inflammation.
High BMI was independently associated with failure to achieve low DAS on initial combination therapy with prednisone and on initial and delayed treatment with IFX. Patients with a high BMI experienced more pain, but not more swelling or systemic inflammation.
评估近期发作的类风湿关节炎患者中，高体重指数（BMI）与治疗反应之间的关系。
在 Behandelstrategien voor Reumatoide Artritis（类风湿关节炎治疗策略）研究中，508 例患者被随机分配至初始单药治疗或联合治疗，包括泼尼松或英夫利昔单抗（IFX）。采用相对危险度（RR）回归分析比较 BMI<25kg/m²和≥25kg/m²患者在接受 DAS≤2.4 指导治疗（首次剂量和 1 年后）时的反应。采用线性混合模型比较 DAS、DAS 各成分以及第 1 年时的功能能力。
高 BMI 与初始治疗时未能达到 DAS≤2.4 独立相关（RR 1.20 [95%置信区间（95%CI）1.05，1.37]）。泼尼松联合治疗的 RR 为 1.55（95%CI 1.06，2.28），IFX 联合治疗的 RR 为 1.42（95%CI 0.98，2.06）。第 1 年后失败的 RR 分别为 1.46（95%CI 0.75，2.83）和 2.20（95%CI 0.99，4.92）。在调整与疾病修饰抗风湿药物治疗失败相关的选择偏差后，IFX 延迟联合治疗失败时，高 BMI 也与 IFX 联合治疗失败相关。在初始单药治疗组未观察到显著相关性。在第 1 年，高 BMI 患者的 DAS 更高，功能能力更差，关节压痛更多，视觉模拟量表整体健康评分更高，但关节肿胀和全身炎症无显著差异。
高 BMI 与初始联合治疗时泼尼松和初始及延迟 IFX 治疗时 DAS 降低相关。高 BMI 患者疼痛更明显，但肿胀和全身炎症无显著差异。
