Sapundzhieva Tanya, Karalilova Rositsa, Batalov Anastas
Department of Internal Diseases, Faculty of Medicine, Medical University of Plovdiv; Plovdiv, Bulgaria.
Rheumatology Clinic, UMHAT 'Kaspela', Plovdiv, Bulgaria.
Curr Rheumatol Rev. 2019;15(3):215-223. doi: 10.2174/1573397115666181130143239.
To investigate the impact of body mass index (BMI) on clinical disease activity indices and clinical and sonographic remission rates in patients with rheumatoid arthritis (RA).
Sixty-three patients with RA were categorized according to BMI score into three groups: normal (BMI<25), overweight (BMI 25-30) and obese (BMI≥30). Thirty-three of them were treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), and 30 with biologic DMARDs (bDMARDs). Patients underwent clinical and laboratory assessment and musculoskeletal ultrasound examination (MSUS) at baseline and at 6 months after initiation of therapy. We evaluated the rate of clinical and sonographic remission (defined as Power Doppler score (PD) = 0) and its correlation with BMI score.
In the csDMARDs group, 60% of the normal weight patients reached DAS28 remission; 33.3% of the overweight; and 0% of the obese patients. In the bDMARDs group, the percentage of remission was as follows: 60% in the normal weight subgroup, 33.3% in the overweight; and 15.8% in the obese. Within the csDMARDs treatment group, two significant correlations were found: BMI score-DAS 28 at 6th month, rs = .372, p = .033; BMI score-DAS 28 categories, rs = .447, p = .014. Within the bDMARDs group, three significant correlations were identified: BMI score-PDUS at sixth month, rs = .506, p =.004; BMI score-DAS 28, rs = .511, p = .004; BMI score-DAS 28 categories, rs = .592, p = .001. Sonographic remission rates at 6 months were significantly higher in the normal BMI category in both treatment groups.
BMI influences the treatment response, clinical disease activity indices and the rates of clinical and sonographic remission in patients with RA. Obesity and overweight are associated with lower remission rates regardless of the type of treatment.
探讨体重指数（BMI）对类风湿关节炎（RA）患者临床疾病活动指数以及临床和超声缓解率的影响。
63例RA患者根据BMI评分分为三组：正常体重（BMI<25）、超重（BMI 25 - 30）和肥胖（BMI≥30）。其中33例接受传统合成改善病情抗风湿药物（csDMARDs）治疗，30例接受生物改善病情抗风湿药物（bDMARDs）治疗。患者在基线及治疗开始后6个月接受临床和实验室评估以及肌肉骨骼超声检查（MSUS）。我们评估了临床和超声缓解率（定义为能量多普勒评分（PD）=0）及其与BMI评分的相关性。
在csDMARDs组中，正常体重患者60%达到DAS28缓解；超重患者为33.3%；肥胖患者为0%。在bDMARDs组中，缓解百分比分别为：正常体重亚组60%，超重患者33.3%，肥胖患者15.8%。在csDMARDs治疗组中，发现两个显著相关性：第6个月时BMI评分与DAS 28，rs = .372，p = .033；BMI评分与DAS 28类别，rs = .447，p = .014。在bDMARDs组中，确定了三个显著相关性：第6个月时BMI评分与PDUS，rs = .506，p =.004；BMI评分与DAS 28，rs = .511，p = .004；BMI评分与DAS 28类别，rs = .592，p = .001。两个治疗组中，正常BMI类别的6个月超声缓解率均显著更高。
BMI影响RA患者的治疗反应、临床疾病活动指数以及临床和超声缓解率。无论治疗类型如何，肥胖和超重均与较低的缓解率相关。
