Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon. CEDOC, NOVA Medical School, Lisbon. Rheumatology Department, Hospital Central do Funchal, Madeira.
Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon. CEDOC, NOVA Medical School, Lisbon.
Acta Reumatol Port. 2021 Jan-Mar;46(1):7-14.
To investigate the relationship between body mass index (BMI) and disease activity in patients with Juvenile Idiopathic Arthritis (JIA).
Patients with JIA, aged ≤18 years, registered at the Rheumatic Diseases Portuguese Register (Reuma.pt) in Portugal and Brazil were included. Age- and sex-specific BMI percentiles were calculated based on WHO growth standard charts and categorized into underweight (P <3), normal weight (3≤P≤85), overweight (85 <P ≤97) and obesity (P >97). Disease activity was assessed by Juvenile Arthritis Disease Activity Score (JADAS-27). Uni- and multivariate analyses were performed.
A total of 275 patients were included. The prevalence of underweight, normal weight, overweight and obesity was 6.9%, 67.3%, 15.3% and 10.5%, respectively. Underweight patients had significantly higher number of active joints (p <0.001), patient's/parent's global assessment of disease activity (PGA) (p=0.020), physician's global assessment of disease activity (PhGA) (p <0.001), erythrocyte sedimentation rate (ESR) (p=0.032) and overall higher JADAS-27 (p <0.001), compared to patients with normal weight, overweight and obesity. In the multivariate regression, underweight persisted significantly associated with higher disease activity, compared to normal weight (B=-9.430, p <0.001), overweight (B=-9.295, p=0.001) and obesity (B=-9.120, p=0.001), when adjusted for age, gender, country, ethnicity, JIA category and therapies used. The diagnosis of RF- (B=3.653, p=0.006) or RF+ polyarticular JIA (B=5.287, p=0.024), the absence of DMARD therapy (B=5.542, p <0.001) and the use of oral GC (B=4.984, p=0.002) were also associated with higher JADAS-27.
We found an independent association between underweight and higher disease activity in patients with JIA. Further studies are needed to understand the underlying mechanisms of this association.
探讨青少年特发性关节炎（JIA）患者的体重指数（BMI）与疾病活动之间的关系。
纳入在葡萄牙和巴西的风湿病葡萄牙登记处（Reuma.pt）登记的 JIA 患者，年龄≤18 岁。根据世界卫生组织生长标准图表计算年龄和性别特异性 BMI 百分位数，并分为消瘦（P＜3%）、正常体重（3%≤P≤85%）、超重（85%＜P≤97%）和肥胖（P＞97%）。采用青少年关节炎疾病活动评分（JADAS-27）评估疾病活动。进行单因素和多因素分析。
共纳入 275 例患者。消瘦、正常体重、超重和肥胖的患病率分别为 6.9%、67.3%、15.3%和 10.5%。与正常体重、超重和肥胖患者相比，消瘦患者的活跃关节数显著更多（p＜0.001），患者/家长的疾病活动总体评估（PGA）（p=0.020）、医生的疾病活动总体评估（PhGA）（p＜0.001）、红细胞沉降率（ESR）（p=0.032）和 JADAS-27 评分整体更高（p＜0.001）。在多因素回归中，与正常体重相比，消瘦与更高的疾病活动显著相关（B=-9.430，p＜0.001），与超重（B=-9.295，p=0.001）和肥胖（B=-9.120，p=0.001）也相关，且在调整年龄、性别、国家、种族、JIA 类别和使用的治疗方法后仍具有统计学意义。RF-（B=3.653，p=0.006）或 RF+多关节 JIA（B=5.287，p=0.024）的诊断、无 DMARD 治疗（B=5.542，p＜0.001）和口服 GC 治疗（B=4.984，p=0.002）也与更高的 JADAS-27 评分相关。
我们发现 JIA 患者中消瘦与更高的疾病活动之间存在独立关联。需要进一步研究以了解这种关联的潜在机制。
