We prospectively evaluated whether obesity impacts achievement of minimal disease activity (MDA) in subjects with psoriatic arthritis (PsA).
Among PsA subjects with an active disease and who were starting a treatment with tumor necrosis factor α blockers, 135 obese (body mass index [BMI] >30 kg/m(2) ) patients and 135 patients of normal weight (controls) were followed up for 24 months. At baseline and at the 12- and 24-month followup, all subjects underwent a clinical, rheumatologic, and laboratory assessment.
With the exception of the prevalence of hypercholesterolemia and hypertriglyceridemia, case and control subjects were similar for all the clinical and demographic characteristics analyzed. At the 12-month followup, in both cases and controls, no significant changes in body weight were found (P > 0.05 for all). MDA was achieved by 98 (36.3%) of the 270 PsA individuals. The prevalence of obesity was higher in those that did not achieve MDA than in those that did (64.0% versus 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% confidence interval [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 first-degree (BMI <30 kg/m(2) ) and second-degree (BMI 30-35 kg/m(2) ) obesity, respectively. Among the 98 subjects who had achieved MDA at the 12-month followup, the presence of obesity was associated with a poor probability of sustained MDA at the 24-month followup (HR 2.04, 95% CI 1.015-3.61; P = 0.014).
Obesity is a negative predictor of achieving and maintaining MDA.