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Vol. 16. Issue 6.
Pages 462-467 (November - December 2020)
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Vol. 16. Issue 6.
Pages 462-467 (November - December 2020)
Original Article
DOI: 10.1016/j.reumae.2018.11.014
Association between overweight/obesity and clinical activity in rheumatoid arthritis
Asociación entre sobrepeso/obesidad y estado clínico en artritis reumatoide
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José Alvarez-Nemegyeia, Elda Pacheco-Pantojab,
Corresponding author
elda.pacheco@anahuac.mx

Corresponding author.
, Melina González-Salazarc, Ricardo Francisco López-Villanuevad, Sherlin May-Kime, Liliane Martínez-Vargase, Daniel Quintal-Gutiérreze
a Star Medica Merida Hospital, Mérida, Yucatán, Mexico
b Medicine School, Health Sciences Division, Universidad Anáhuac Mayab, Mérida, Yucatán, Mexico
c Instituto Mexicano del Seguro Social, Delegación Yucatán, Mérida, Yucatán, Mexico
d Hospital Regional ISSSTE, Mérida, Yucatán, Mexico
e Nutrition School, Universidad Anáhuac Mayab, Mérida, Yucatán, Mexico
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Tables (6)
Table 1. Clinical and demographic profile of the patients studied.
Table 2. Results of evaluation of body composition in the study group (n=123).
Table 3. Classification of body composition type according to BMI results.
Table 4. Evaluation of the association between dichotomised body composition categories (according to the BMI) and inflammation status evaluated by the DAS 28-ESR*.
Table 5. Comparison between degrees of inflammatory activity, physical function and type of treatment, according to dichotomised BMI body composition categories.
Table 6. Correlations (by Pearson coefficients) between the methods used to evaluate body composition and the level of inflammatory activity, physical function and the required treatment of RA.
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Abstract
Introduction

The effect of overweight/obesity on clinical status in rheumatoid arthritis (RA) is still a controversial topic.

Aim

To assess the association between body composition and clinical status in RA patients.

Methods

A prospective, comparative, cross-sectional study was performed on 123 (98.4% women, 86.3% FR+, 9.3±8.7 duration years) RA patients diagnosed according to ACR/EULAR 2010 criteria who were assessed for inflammatory activity (DAS 28), functional status (HAQ-Di), and type of treatment. Body composition was evaluated by BMI, waist, hip, and middle arm girths, waist/hip ratio, skin fold measurements, and bioelectrical impedance analysis.

Results

The prevalence of overweight and obesity (BMI-WHO cut-off points) was 30.9% and 45.5% respectively. Using Stavropoulos-Kalinoglou cut-off points, each corresponding prevalence increased to 31.7% and 58.5%, respectively. Pooled patients in the overweight/obesity classification (Stavropoulos-Kalinoglou classification) exhibited a significantly higher number of swollen joints as compared to subnormal/normal body composition subjects (3.8±3.3 vs 1.9±2.5; P=.02). Swollen joint count showed significant positive correlation with 6 out of 11 body composition parameters: BMI; arm and hip girths, triceps skin fold, body fat average determined by bioelectrical impedance analysis, and skin fold measurements.

Conclusions

Prevalence of obesity in RA varies according to BMI cut-off points. Overweight and obesity were associated with higher inflammatory activity characterised by a higher count of tender and swollen joints. A positive correlation was found between swollen joint amount and the majority of the body fat mass indicators assessed. Body composition assessment/improvement should be an important part of the routine care of RA patients.

Keywords:
Rheumatoid arthritis
Inflammatory activity
Overweight
Obesity
Resumen
Introducción

La asociación entre la presencia de sobrepeso/obesidad y el estado clínico de la artritis reumatoide (AR) es un tema aún no resuelto.

Objetivo

Evaluar la asociación entre el tipo de composición corporal y el estado clínico en pacientes con AR.

Métodos

Estudio prospectivo, comparativo y transversal que incluyó a 123 pacientes (98,4% mujeres, 86,3% FR+, 9,3±8,7 años de duración) con AR (criterios ACR/EULAR 2010) en quienes se determinó actividad inflamatoria (DAS 28), estado funcional (HAQ-Di) y tipo de tratamiento; además, el tipo de composición corporal evaluada por IMC, circunferencias de cintura, cadera y brazo medio, índice cintura/cadera, plicometría y bioimpedancia eléctrica.

Resultados

Las prevalencias de sobrepeso y obesidad (IMC-OMS) fueron del 30,9% y del 45,5%. Cuando se reclasificaron mediante los puntos de corte de Stavropoulos-Kalinoglou, las prevalencias aumentaron a 31,7 y 58,5%, respectivamente. Con este criterio, los pacientes con sobrepeso/obesidad tuvieron más articulaciones inflamadas que los pacientes con composición corporal subnormal/normal (3,8±3,3 vs 1,9±2,5; p=0,02). El conteo de articulaciones inflamadas mostró correlación positiva significativa con 6 de 11 métodos antropométricos: IMC, circunferencia de brazo y cadera, pliegue tricipital y porcentaje de grasa corporal (determinado por bioimpedancia eléctrica y plicometría).

Conclusiones

El sobrepeso y la obesidad se asociaron a mayor actividad inflamatoria caracterizada por mayor cantidad de articulaciones inflamadas. Encontramos correlación positiva significativa entre el número de articulaciones inflamadas y la mayoría de los indicadores de masa grasa corporal estudiados. La evaluación y optimización de la composición corporal podría llegar a ser una parte importante para el abordaje clínico de pacientes con AR.

Palabras clave:
Artritis reumatoide
Actividad inflamatoria
Sobrepeso
Obesidad

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