OBJECTIVE.: Obesity is a mild, long-lasting inflammatory disease and, as such, could increase rheumatoid arthritis (RA) inflammatory burden. The study aim was to determine whether obesity represents a risk factor for a poor remission rate in RA patients requiring anti-TNFα therapy for progressive and active disease despite Methotrexate or other DMARDs treatment. METHODS.: Patients were identified from fifteen outpatient clinics of university-hospitals and hospitals in Italy, taking part in the GISEA (Gruppo Italiano Studio Early Arthritis) network. Disease activity score (DAS28 joints), body mass index (BMI: categorized as a BMI <25, BMI 25-30 and BMI >30), acute phase reactants, rheumatoid factor IgM, anti-cyclic citrullinated peptide, values were collected. DAS28 remission was defined as a score <2.6 lasting for at least 3 months. RESULTS.: 641 outpatients with long standing RA, receiving anti-TNFα blockers (Adalimumab, n=260; Etanercept, n=227; Infliximab, n=154), recruited from 2006 to 2009 and monitored for at least 12 months, were analyzed. The DAS28 at the baseline was 5.6±1.4. A BMI value >30 was recorded in 66 out of 641 RA patients (10.3%). After 12 months of anti-TNFα treatment, a DAS28<2.6 was noted in 15.2% of the obese subjects, in 30.4% of the patients with a BMI 25-30 and in 32.9% of the patients with a BMI<25 (p=0.01). The lowest percentage of remission, statistically significant versus adalimumab and etanercept (p=0.003), was observed with infliximab. CONCLUSIONS.: Obesity represents a risk factor for a poor remission rate in long standing RA treated with anti-TNFα. A personalized treatment might be a possible solution.
Gremese, E., Carletto, A., Padovan, M., Atzeni, F., Raffeiner, B., Giardina, A., Favalli, E., Erre, G., Gorla, R., Galeazzi, M., Foti, R., Cantini, F., Salvarani, C., Olivieri, I., Lapadula, G., Ferraccioli, G., Obesity reduces the response rate to anti TNFα in rheumatoid arthritis. an approach to a personalized medicine, <<ARTHRITIS CARE & RESEARCH>>, 2012; (Giugno): 1-10. [doi:10.1002/acr.21768] [http://hdl.handle.net/10807/31457]
Obesity reduces the response rate to anti TNFα in rheumatoid arthritis. an approach to a personalized medicine
Gremese, Elisa;Ferraccioli, Gianfranco
2012
Abstract
OBJECTIVE.: Obesity is a mild, long-lasting inflammatory disease and, as such, could increase rheumatoid arthritis (RA) inflammatory burden. The study aim was to determine whether obesity represents a risk factor for a poor remission rate in RA patients requiring anti-TNFα therapy for progressive and active disease despite Methotrexate or other DMARDs treatment. METHODS.: Patients were identified from fifteen outpatient clinics of university-hospitals and hospitals in Italy, taking part in the GISEA (Gruppo Italiano Studio Early Arthritis) network. Disease activity score (DAS28 joints), body mass index (BMI: categorized as a BMI <25, BMI 25-30 and BMI >30), acute phase reactants, rheumatoid factor IgM, anti-cyclic citrullinated peptide, values were collected. DAS28 remission was defined as a score <2.6 lasting for at least 3 months. RESULTS.: 641 outpatients with long standing RA, receiving anti-TNFα blockers (Adalimumab, n=260; Etanercept, n=227; Infliximab, n=154), recruited from 2006 to 2009 and monitored for at least 12 months, were analyzed. The DAS28 at the baseline was 5.6±1.4. A BMI value >30 was recorded in 66 out of 641 RA patients (10.3%). After 12 months of anti-TNFα treatment, a DAS28<2.6 was noted in 15.2% of the obese subjects, in 30.4% of the patients with a BMI 25-30 and in 32.9% of the patients with a BMI<25 (p=0.01). The lowest percentage of remission, statistically significant versus adalimumab and etanercept (p=0.003), was observed with infliximab. CONCLUSIONS.: Obesity represents a risk factor for a poor remission rate in long standing RA treated with anti-TNFα. A personalized treatment might be a possible solution.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.