Philadelphia VA Medical Center, Philadelphia, PA, USA.
University of Pennsylvania, Philadelphia, PA, USA.
Clin Rheumatol. 2021 Jun;40(6):2419-2426. doi: 10.1007/s10067-020-05508-3. Epub 2020 Nov 25.
We assessed the impact of adjustment of the multi-biomarker disease activity score (MBDA) for age, sex, and leptin, over the range of age and adiposity, and assessed relationships with clinical disease activity.
Patients with RA, ages 18-75 years, were recruited from clinical practices and completed whole-body DXA to quantify fat mass indices (FMI, kg/m). FMI Z-scores were calculated based on distributions in a reference population. Descriptive statistics described relationships between age, FMI Z-score, and the original MBDA and adjusted MBDA (aMBDA). Swollen joint counts (SJC) and the clinical disease activity index (CDAI) were assessed over MBDA categories.
There were 104 participants (50% female) with mean (SD) age of 56.1 (12.5) and body mass index (BMI) of 28.8 (6.9). Older age was associated with higher MBDA scores in men. The aMBDA was not associated with age. The original MBDA score was associated with FMI Z-score among women (Rho = 0.42, p = 0.002) but not men. The aMBDA was not associated with FMI Z-score in either women or men. The aMBDA score was lower than the original MBDA in the highest quartile of FMI in women and was higher in the lowest FMI quartiles in women and men. CDAI, SJC, and radiographic scores were similar across activity categories for the original MBDA score and aMBDA.
The aMBDA demonstrated reduced associations with adiposity, particularly among women. The aMBDA may be less likely to overestimate disease activity in women with greater adiposity and to underestimate disease activity in men and women with lesser adiposity. Key Points • Leptin adjustment of the MBDA score reduces the influence of adiposity, particularly among women. • Leptin adjustment results in significantly higher estimated disease activity in thin men and women. • The adjusted and unadjusted score correlate similarly with clinical disease activity measures.
我们评估了多生物标志物疾病活动评分（MBDA）针对年龄、性别和瘦素的调整，在年龄和肥胖范围内，评估与临床疾病活动的关系。
18-75 岁的 RA 患者从临床实践中招募，并完成全身 DXA 以量化脂肪量指数（FMI，kg/m）。FMI Z 分数根据参考人群的分布计算。描述性统计描述了年龄、FMI Z 分数与原始 MBDA 和调整 MBDA（aMBDA）之间的关系。在 MBDA 类别中评估肿胀关节计数（SJC）和临床疾病活动指数（CDAI）。
共有 104 名参与者（50%为女性），平均（SD）年龄为 56.1（12.5），体重指数（BMI）为 28.8（6.9）。男性年龄较大与 MBDA 评分较高相关。aMBDA 与年龄无关。原始 MBDA 评分与女性的 FMI Z 分数相关（Rho=0.42，p=0.002），但与男性无关。aMBDA 与女性或男性的 FMI Z 分数无关。在女性 FMI 最高四分位数中，aMBDA 评分低于原始 MBDA，在女性和男性的最低 FMI 四分位数中，aMBDA 评分较高。原始 MBDA 评分和 aMBDA 的 CDAI、SJC 和放射评分在活动类别中相似。
aMBDA 与肥胖的相关性降低，尤其是在女性中。在肥胖程度较高的女性中，aMBDA 不太可能高估疾病活动，在肥胖程度较低的男性和女性中，aMBDA 不太可能低估疾病活动。关键点•MBDA 评分的瘦素调整降低了肥胖的影响，尤其是在女性中。•瘦素调整导致瘦男和瘦女的估计疾病活动显著增加。•调整和未调整的评分与临床疾病活动测量结果相关性相似。
