Body mass index may impact remission from rheumatoid arthritis

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Most treatment strategies used against rheumatoid arthritis are intended to relieve pain and induce inflammation. Whenever patients become asymptomatic for extended periods of time, it is known as a period of remission, which can be documented and described within the individual patient narrative of an orthopedic EMR system.

The best way to induce and sustain remission has not always been clear. However, treatment has typically been a combination of several approaches, including medication, rest, healthy eating and, in extreme cases, surgery. One team of scientists from the Hospital for Special Surgery suggested that individuals' body mass indexes can influence the occurrence of remission, as presented at the American College of Rheumatology annual meeting.

What is the burden of rheumatoid arthritis?
In people who have rheumatoid arthritis, the immune system launches abnormal attacks against the tissues that line the joints, leading to inflammation, swelling, pain, stiffness and other symptoms. About 1.5 million individuals in the U.S. live with this condition, as estimated by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Because of the potential impact on patients' quality of life, rheumatoid arthritis is also associated with depression, anxiety, feelings of helplessness and low self-esteem.

Usually, doctors can prescribe various medications to treat rheumatoid arthritis, including disease-modifying antirheumatic drugs, corticosteroids or non-steroidal anti-inflammatory medications. Additionally, providers recommend that patients get plenty of rest, exercise to maintain muscle strength, manage stress and eat a balanced diet.

Both underweight and overweight individuals face risks
To better understand the relationship between BMI and the occurrence of remission among rheumatoid arthritis patients, the authors of the new study monitored 944 individuals who were diagnosed with the disease within the preceding 12 months. All research participants were divided into six categories of BMI according to standards set down by the World Health Organization, and underwent at least two consecutive symptom evaluations under the Disease Activity Score for RA test during the course of three years. Remission was defined as low disease activity between two doctors' visits that were three to six months apart.

Ultimately, 2 percent of study subjects were underweight, while 65 percent of them were either overweight or obese.

"What's striking is that if you look at the BMI classifications, all the patients in the underweight or overweight categories were much less likely to achieve sustained remission compared to those with a normal BMI," Susan Goodman, M.D., a rheumatologist at HSS, said in a statement. "Patients who were severely obese had an even lower chance of achieving sustained remission. Individuals in the highest BMI categories also had more inflammation and more pain."

Aside from BMI, other factors that were independently associated with sustained remission included non-smoking status, early use of methotrexate and positive response to treatment within the first six months of initiation.

"Our findings represent the first study to present evidence that BMI should be considered among the modifiable risk factors for poor [rheumatoid arthritis] outcomes," Goodman added. "There are many things patients can do to manage the disease. Along with timely diagnosis and treatment, weight control and other good practices can result in better outcomes."

According to the U.S. Centers for Disease Control and Prevention, weight loss is achievable by burning more calories than are consumed in a day. However, this must occur at a healthy pace, which is about 1 to 2 pounds per week. Both nutrition and physical activity must be taken into account when designing a weight loss plan. When it comes to diet, patients should emphasize fresh produce, low-fat or fat free dairy, lean protein and foods low in saturated fat, trans fat and added sugar. For exercise, individuals should engage in 150 minutes of moderate-intensity aerobic activity per week.