前沿|超重和肥胖可降低RA患者病情达持续缓解的可能性-风湿界
本研究是目前有关肥胖与RA疾病活动度负向相关的最大研究队列,这也呼吁人们应在RA患者中更好的控制这一风险因素。
摘 要
目的:肥胖与RA的发病、疾病严重程度、治疗结局和反应均相关。我们在诊断RA后随访3年的患者评估超重和肥胖对于患者达到持续缓解的独立影响。
方法:本研究的资料来源于加拿大早期类风湿关节炎研究队列。持续的疾病缓解定义为DAS28小于2.6持续2个连续的随访周期。入组患者根据体重指数进行分层(BMI18.5-24.9健康;BMI25-29.9超重;BMI≥30肥胖)。在控制年龄、性别、种族、教育程度、RA持续病程、吸烟状态、合并症、基线DAS28、HAQ-DI和起始治疗的因素下,采用Cox回归模型评估BMI分级对于患者达到持续疾病缓解可能的影响星际禁区。
结论:入组982例患者,其中正常体重患者315例,超重患者343例和肥胖患者324例丁惟宁 ,其中总共355例患者在随访3年时间内达到了持续缓解。起始治疗方案在不同BMI分级间无差异。但与正常体重患者相比,超重和肥胖患者能够达到持续疾病缓解的可能性更小。
结论:在本研究队列中超重和肥胖的发生率非常高(69%)。虽然在起始治疗方案和后续生物制剂使用方面无差异羊皮卷之三 ,但超重和肥胖患者较正常体重患者更少比例的达到持续缓解。本研究是目前有关肥胖与RA疾病活动度负向相关的最大研究队列,这也呼吁人们应在RA患者中更好的控制这一风险因素。
原 文
Abstract
OBJECTIVE: Obesity is implicated in RA development喜盈门意千重 , severity陈莲笙 , outcomes and treatment response. We estimated the independent effects of overweight and obesity on ability to achieve sustained remission (sREM) in the three years following RA diagnosis.
METHODS:Data were from the Canadian Early Arthritis Cohort, a multicenter observational trial of ERA patients treated by rheumatologists using guideline-based care. sREM was defined as DAS28 <2.6 for two consecutive visits. Patients were stratified by BMI (healthy [18.5-24.9]; overweight [25-29.9]; and obese [≥30]). Cox regression was used to estimate the effect of BMI category on probability of achieving sREM over the first 3 years, controlling for age李林金, sex, race, education, RA duration, smoking status, comorbidities, baseline DAS28, HAQ-DI, CRP衙内当官 , and initial treatment.
RESULTS: Of 982 patients, 315 (32%) had a healthy BMI, 343 (35%) were overweight韩以烈, and 324 (33%) were obese; 355 (36%) achieved sREM within 3 years. Initial treatment did not differ by BMI category. Compared to healthy BMI安小乔 , overweight (HR= 0.75, 95% CI 0.58-0.98) and obese (HR= 0.53, 95% CI: 0.39-0.71) patients were significantly less likely to achieve sREM.
CONCLUSION: Rates of overweight and obesity were high (69%) in this ERA cohort. Overweight patients were 25%, and obese patients were 47% less likely to achieve sREM in the first 3 years despite similar initial DMARD treatment and subsequent biologic use. This is the largest study demonstrating the negative impact of excess weight on RA disease activity and supports a call to action to better identify and address this risk in RA patients.
引自:Schulman E, Bartlett SJ, Schieir O, Andersen KM, Boire G, Pope JE, Hitchon C, Jamal S, Thorne CJ清风修仙录 , Tin D,陈子湄 Keystone EC, Haraoui B吴岱豪, Goodman SM凯立德手机导航软件破解版 胡文海视频, Bykerk VP, Investigators C.Overweight and Obesity Reduce the Likelihood of Achieving Sustained Remission in Early Rheumatoid Arthritis: Results from the Canadian Early Arthritis Cohort Study. Arthritis Care Res (Hoboken).2017 Nov 30.
翻译:北医三院李常虹
来源:中国风湿病公众论坛