Background: Growing evidence on the negative role of overweight and obesity on the health outcomes of patients with axial spondyloarthritis (axSpA) exists.
Objectives: The aim of the study is to evaluate the association between Body Mass Index (BMI) categories and sociodemographic, disease-characteristics and patient-reported outcomes (PROs) in a large sample of axSpA patients.
Methods: Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries were analyzed. Using self-reported height and weight patients were classified into under and normal weight (<24.9 Kg/m2), overweight (25.0-29.9Kg/m2) or obese (>30.0Kg/m2) following WHO guidelines. The Kruskal-Wallis test was used to compare the means of numerical variables between polytomous variables, the χ2 test was used to compare the distribution between the categorical variables. Simple and multivariate logistic regression were used to identify possible associated factors.
Results: A total 2,846 axSpA patients participated in the EMAS survey: mean age was 43.9 years, 61.3% female, 48.1% had a university degree and 67.9% were married and 71.3% were HLA-B27 positive. The percentage of patients with obesity was 18.7%, overweight 33.5%, normal weight 44.0% and underweight 3.8% with an accumulate prevalence of overweight/obesity of 52.2% (compared to 51.6 % of the EU’s population1). Those with obesity engage less frequently in sport (50.1% vs 33.3%; p<0.001) and in intimate relationships since disease onset (36.5% vs 20.4%; p<0.001), have higher functional limitations when tying shoe laces (46.8% vs 33.6%; p<0.001) and higher functional limitations regarding housework (52.2% vs 48.2%; p=0.024). Furthermore, they present greater disease activity (6.1±1.8 vs 5.4±2.0; p<0.001) and spinal stiffness (8.6±2.3 vs 7.4±2.5; p<0.001) compared to under and normal weight. For obese patients, the percentage of depression is higher (34.5% vs 23.7%; p<0.001), presenting a poorer mental health (5.7 ± 4.3 vs 5.0 ±4.2; p<0.001). The factors most strongly associated with obesity were higher functional limitation when tying shoe laces (OR=1.467; p<0.001), the female gender (OR=1.433; p<0.001) and lesser frequency of intimate relation (OR=1.239; p<0.001; see Table 1).
Conclusion: Results from the largest European axSpA survey reveal a similar prevalence of overweight and obesity to the general population. However, compared to normal weight, obese patients present greater disease activity, spinal stiffness and poorer mental health. Additionally, women with axSpA appear to be more vulnerable than men to obesity.
References: EU Eurostat. Overweight and obesity - BMI statistics.
Acknowledgements: This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.
Disclosure of Interests: Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Raj Mahapatra: None declared, Souzi Makri: None declared, Sergio Sanz-Gómez: None declared, José Correa-Fernández: None declared, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.
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