Tidblad Liselotte, Öberg Sysojev Anton, Delcoigne Bénédicte, Klareskog Lars, Alfredsson Lars, Askling Johan, Westerlind Helga, Saevarsdottir Saedis
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
RMD Open. 2025 Apr 15;11(2):e005430. doi: 10.1136/rmdopen-2025-005430.
To examine whether obesity and/or overweight are independently associated with an increased risk of remission failure in patients with early rheumatoid arthritis (RA), treated with methotrexate as first disease-modifying antirheumatic drug, or if the previously reported associations could be explained by underlying comorbidities and lifestyle factors.
For patients included in the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) study 2006-2018 initiating methotrexate monotherapy (n=1285), we captured data on body mass index, comorbidities and disease activity from EIRA and through linkage to nationwide Swedish clinical and quality registers. The primary outcome was failure to reach 28-joint Disease Activity Score (DAS28) remission at 3 and 6 months. Secondary outcomes included Boolean, Simplified Disease Activity Index and Clinical Disease Activity Index remission and their individual components. We estimated the relative risk (RR) of remission failure in patients with obesity and overweight compared with normal weight using modified Poisson regression, adjusting for potential confounders.
After 6 months, 64% (n=98/153) of patients with obesity, 52% (n=171/326) with overweight and 48% (n=210/433) with normal weight failed to reach DAS28 remission, with an RR of 1.33 (95% CI 1.14 to 1.55) for patients with obesity after adjustment for age and sex. The increased risk of remission failure in patients with obesity remained after further adjustment for seropositivity, educational level, smoking, alcohol use, physical activity, calendar period, glucocorticoid treatment and comorbidities (RR=1.27, 95% CI 1.08 to 1.50). No significant association was observed for patients with overweight. The results were similar for the secondary outcomes and after 3 months.
Obesity is a risk factor for remission failure in early RA, independent of comorbid conditions.
探讨肥胖和/或超重是否与早期类风湿关节炎（RA）患者缓解失败风险增加独立相关，这些患者以甲氨蝶呤作为首个改善病情抗风湿药物进行治疗，或者之前报道的关联是否可由潜在的合并症和生活方式因素来解释。
对于2006 - 2018年类风湿关节炎流行病学调查（EIRA）研究中开始甲氨蝶呤单药治疗的患者（n = 1285），我们从EIRA并通过与瑞典全国临床和质量登记处的链接获取了体重指数、合并症和疾病活动的数据。主要结局是在3个月和6个月时未达到28个关节疾病活动评分（DAS28）缓解。次要结局包括布尔值、简化疾病活动指数和临床疾病活动指数缓解及其各个组成部分。我们使用修正的泊松回归估计肥胖和超重患者与正常体重患者相比缓解失败的相对风险（RR），并对潜在混杂因素进行调整。
6个月后，肥胖患者中有64%（n = 98/153）、超重患者中有52%（n = 171/326）、正常体重患者中有48%（n = 210/433）未达到DAS28缓解，在对年龄和性别进行调整后，肥胖患者的RR为1.33（95%CI 1.14至1.55）。在进一步对血清学阳性、教育水平、吸烟、饮酒、身体活动、日历时间、糖皮质激素治疗和合并症进行调整后，肥胖患者缓解失败风险增加的情况仍然存在（RR = 1.27，95%CI 从1.08至1.50）。超重患者未观察到显著关联。次要结局以及3个月后的结果相似。
肥胖是早期类风湿关节炎缓解失败的一个风险因素，独立于合并症情况。
Zotero 插件
