Baker Joshua F, Cannon Grant W, Ibrahim Said, Haroldsen Candace, Caplan Liron, Mikuls Ted R
From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center.
J Rheumatol. 2015 Jun;42(6):920-7. doi: 10.3899/jrheum.141363. Epub 2015 Apr 1.
Low body mass index (BMI) is a risk factor for poor longterm outcomes in rheumatoid arthritis (RA). The purpose of this study was to identify factors associated with longterm changes in BMI.
Subjects with RA from the Veterans Affairs (VA) Rheumatoid Arthritis (VARA) Registry (n = 1474) were studied. Information on inflammatory markers, presence of erosions, and smoking status were extracted from the VARA database. BMI was extracted from VA electronic medical records within 14 days of each visit date. VA pharmacy records were queried to identify prescriptions for specific RA therapies within 1 month of the visit date. We used robust generalized estimating equations marginal regression models to calculate independent associations between clinical variables and BMI over time. Similar models determined predictors of change in weight and risk of weight loss over the subsequent study observation period.
Increasing age, active smoking, and the presence of erosions at baseline were associated with lower BMI. Weight decreased over time among older adults. Factors associated with greater reductions in BMI over time and a greater risk of weight loss were higher inflammatory markers, smoking, older age, higher BMI, and less subsequent improvement in inflammation. Methotrexate use was associated with a lower risk of weight loss. The use of prednisone or anti-tumor necrosis factor therapies was not associated with change in BMI or the risk of weight loss independent of other factors.
Greater age, greater inflammatory activity, and active smoking are associated with greater weight loss in RA over time.
低体重指数（BMI）是类风湿关节炎（RA）长期预后不良的一个风险因素。本研究的目的是确定与BMI长期变化相关的因素。
对退伍军人事务部（VA）类风湿关节炎（VARA）登记处的RA患者（n = 1474）进行研究。从VARA数据库中提取炎症标志物、侵蚀情况和吸烟状况等信息。在每次就诊日期的14天内从VA电子病历中提取BMI。查询VA药房记录以确定就诊日期1个月内特定RA治疗的处方。我们使用稳健广义估计方程边际回归模型来计算临床变量与BMI随时间的独立关联。类似模型确定了后续研究观察期内体重变化的预测因素和体重减轻的风险。
年龄增加、当前吸烟以及基线时存在侵蚀与较低的BMI相关。老年人的体重随时间下降。随着时间推移BMI降低幅度更大以及体重减轻风险更高的相关因素包括炎症标志物水平较高、吸烟、年龄较大、BMI较高以及炎症后续改善较少。使用甲氨蝶呤与体重减轻风险较低相关。使用泼尼松或抗肿瘤坏死因子疗法与BMI变化或体重减轻风险无关，独立于其他因素。
随着时间推移，年龄较大、炎症活动度较高和当前吸烟与RA患者体重减轻幅度更大相关。
