Obesity Is Common in Axial Spondyloarthritis and Is Associated with Poor Clinical Outcome

Fiona Maas; Suzanne Arends; Eveline van der Veer; Freke Wink; Monique Efde; Hendrika Bootsma; Elisabeth Brouwer; Anneke Spoorenberg

doi:10.3899/jrheum.150648

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Table 1.

Patient characteristics and clinical outcome of patients with axSpA, stratified for BMI categories. Values are n (%), mean ± SD, or median (range).

Characteristics	All Patients, n = 461	Normal Weight, < 25.0 kg/m², n = 188	Overweight, 25.0 to < 30.0 kg/m², Obese, n = 173	≥ 30.0 kg/m², n = 100
Age, yrs	45.3 ± 12.8	40.3 ± 12.1	48.2 ± 12.4^*	49.6 ±11.6^*
Male	303 (66)	117 (63)	124 (72)	62 (62)
Symptom duration, yrs	17 (0–61)	13 (0–53)	20 (1–61)^*	19 (0–54)^*
Time since diagnosis, yrs	8 (0–54)	7 (0–41)	10 (0–48)	8 (0–54)
HLA-B27+	361 (80)	155 (84)	138 (82)	68 (69)^*^†
BMI, kg/m²	26.5 ± 4.6	22.3 ± 1.9	27.2 ± 1.4	33.2 ± 3.1
History of IBD	62 (14)	26 (14)	19 (11)	17 (17)
History of uveitis	146 (33)	63 (34)	55 (32)	28 (28)
History of psoriasis	52 (11)	16 (9)	23 (13)	13 (13)
Presence of peripheral arthritis	16 (4)	9 (5)	4 (2)	3 (3)
Presence of entheseal involvement	160 (36)	63 (35)	57 (34)	40 (42)
NSAID use	228 (50)	94 (50)	80 (46)	54 (54)
DMARD use	32 (7)	16 (9)	10 (6)	6 (6)
TNF-α inhibitor use	204 (44)	79 (42)	84 (49)	41 (41)
Comorbidity	198 (43)	55 (30)	82 (48)^*	61 (62)^*^†
CVD	35 (8)	10 (5)	14 (8)	11 (11)
Hypertension	105 (23)	15 (8)	45 (26)^*	45 (45)^*^†
Diabetes	16 (4)	3 (2)	6 (4)	7 (7)
Lung disease	28 (6)	8 (4)	11 (6)	9 (9)
Ulcer/stomach disease	5 (1)	1 (1)	3 (2)	1 (1)
Kidney disease	5 (1)	2 (1)	2 (1)	1 (1)
Liver disease	3 (1)	1 (1)	1 (1)	1 (1)
Anemia/blood disease	6 (1)	3 (2)	2 (1)	1 (1)
Cancer	6 (1)	4 (2)	1 (1)	1 (1)
Depression	12 (3)	7 (4)	3 (3)	3 (3)
OA or FM	20 (4)	7 (4)	7 (4)	6 (6)
Noninflammatory back pain	6 (1)	2 (1)	4 (2)	0 (0)
Other chronic rheumatic disease	10 (2)	3 (2)	5 (3)	2 (2)
Other^‡	62 (13)	14 (7)	30 (17)^*	18 (18)^*
BASDAI, 0–10	3.8 ± 2.3	3.8 ± 2.3	3.5 ± 2.1	4.5 ± 2.3^*^†
ASDAS	2.4 ± 1.0	2.3 ± 1.0	2.2 ± 0.8	2.8 ± 1.1^*^†
CRP, mg/l	3 (0–94)	3 (0–73)	3 (1–94)	5 (1–82)^*^†
ESR, mm/h	9 (1–79)	8 (1–71)	8 (2–79)	13 (2–66)^*^†
BASFI, 0–10	3.3 (0–9.9)	2.9 (0–9.1)	2.9 (0–9.9)	5.2 (0.1–9.7)^*^†
ASQoL, 0–18	6 (0–18)	5 (0–17)	4 (0–17)	8 (0–18)^*^†

↵‡ Irritable bowel syndrome, other eye/skin problems, headache, thyroid problems, allergy, and osteoporosis.
↵* P values ≤ 0.05 compared with patients with normal weight.
↵† P values ≤ 0.05 compared with patients with overweight. axSpA: axial spondyloarthritis; BMI: body mass index; IBD: inflammatory bowel disease; NSAID: nonsteroidal antiinflammatory drug; DMARD: disease-modifying antirheumatic drug; TNF-α: tumor necrosis factor-α; CVD: cardiovascular disease; OA: osteoarthritis; FM: fibromyalgia syndrome; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; ASDAS: Ankylosing Spondylitis Disease Activity Score; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; BASFI: Bath Ankylosing Spondylitis Functional Index; ASQoL: Ankylosing Spondylitis Quality of Life questionnaire.

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Table 2.

Univariable and multivariable linear regression analysis of the association between BMI and obesity with clinical outcome.

Dependent Variables	Predicting Variables	Univariable Analysis, B (95% CI)	p	Multivariable Analysis^*, B (95% CI)	p
BASDAI	BMI	0.056 (0.011–0.101)	0.014	0.047 (−0.004–0.099)	0.072
BASDAI	Obesity	0.841 (0.341–1.341)	0.001	0.629 (0.080–1.179)	0.025
ASDAS	BMI	0.036 (0.016–0.057)	< 0.001	0.033 (0.010–0.057)	0.005
ASDAS	Obesity	0.526 (0.299–0.752)	< 0.001	0.497 (0.248–0.746)	< 0.001
CRP (log)	BMI	0.015 (0.006–0.023)	0.001	0.017 (0.007–0.026)	0.001
CRP (log)	Obesity	0.186 (0.092–0.279)	< 0.001	0.231 (0.130–0.333)	< 0.001
ESR (log)	BMI	0.013 (0.005–0.021)	0.003	0.013 (0.003–0.022)	0.009
ESR (log)	Obesity	0.116 (0.020–0.211)	0.017	0.118 (0.015–0.220)	0.024
BASFI	BMI	0.133 (0.083–0.183)	< 0.001	0.073 (0.019–0.128)	0.009
BASFI	Obesity	1.609 (1.056–2.163)	< 0.001	1.040 (0.460–1.619)	< 0.001
ASQoL	BMI	0.147 (0.042–0.252)	0.006	0.086 (−0.031–0.204)	0.150
ASQoL	Obesity	2.891 (1.744–4.038)	< 0.001	2.157 (0.878–3.435)	0.001

↵* Adjusted for age, sex, symptom duration, HLA-B27 status, and comorbidity. BMI: body mass index; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; ASDAS: Ankylosing Spondylitis Disease Activity Score; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; BASFI: Bath Ankylosing Spondylitis Functional Index; ASQoL: Ankylosing Spondylitis Quality of Life questionnaire.