Background Clinical studies show an increased prevalence of obesity in PsA patients. By leading to an abnormal expression of “adipokines” (TNF-α, IL-6, leptin, adiponectin), obesity determines a pro-inflammatory status. Thus, an interaction between obesity-related and immunity-related inflammatory status may be postulated in obese PsA subjects.
Objectives We prospectively evaluated whether the presence of obesity impacts on the achievement of the Minimal Disease Activity (MDA) in subjects with PsA.
Methods Among PsA subjects with an active disease starting a treatment with TNF-α blockers, 135 obese (Body Mass Index >30) and 135 matched normal-weighted patients (controls) were followed-up for 24 months. At baseline, at 12 and at 24 months follow-up, all subjects underwent a clinical, rheumatologic and laboratory assessment to evaluate the MDA achievement.
Results Demographic and clinical data were similar between case and control subjects. Table 1. At 12 months follow-up, MDA was achieved by 98/270 PsA individuals (36.3%). The prevalence of obesity was higher in those not achieving the MDA than in those achieving it (64.0% vs 25.5%, p<0.001). After adjusting for all the other variables, obesity was associated with a higher risk of not achieving MDA (hazard ratio [HR]: 4.90, 95%CI:3.04-7.87, p<0.001). The HR of not achieving MDA was 3.98 (95%CI:1.96-8.06, p<0.001) and 5.40 (95%CI:3.09-9.43, p<0.001) in subjects with 1st degree (<30 BMI) and 2nd degree (30-35 BMI) obesity, respectively. Among the 98 subjects that had achieved MDA at the 12 months follow-up, the presence of obesity was associated with a poor probability of sustained MDA at 24-months follow-up (HR:2.04, 95%CI:1.015-3.61, p=0.014).
Conclusions This prospective study shows that, after adjusting for all the other clinical and demographical variables, the obesity acts as a negative predictor of achieving and maintaining MDA.
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Di Minno MN, Iervolino S, Peluso R, Scarpa R, Di Minno G on behalf of the CaRRDs study group. Carotid intima-media thickness in psoriatic arthritis: differences between tumor necrosis factor-α blockers and traditional disease-modifying antirheumatic drugs. Artherioscler Thromb Vasc Biol. 2011;31:705-12.
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Disclosure of Interest None Declared
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