The impact of obesity on inflammatory markers used in the assessment of disease activity in rheumatoid arthritis – a cross-sectional study
Department of Rheumatology, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India
Centre for Excellence in Diabetes, Obesity and Cholesterol, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India
Data nadesłania: 14-01-2020
Data ostatniej rewizji: 22-02-2020
Data akceptacji: 23-02-2020
Data publikacji online: 28-02-2020
Data publikacji: 28-02-2020
Reumatologia 2020;58(1):9-14
Obesity is known to be associated with elevated levels of inflammatory markers. The aim of the study was to assess the confounding effect of obesity on the levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in patients with rheumatoid arthritis (RA) in low disease activity state or remission as indicated by clinical disease activity index (CDAI).

Material and methods:
Adult RA patients with CDAI less than 10 were divided into two groups: obese and non-obese, based on body mass index. Relevant exclusions were applied to eliminate causes of raised inflammatory markers other than obesity. The difference of CRP and ESR levels between the obese and non-obese groups was analyzed.

Obese patients with RA (n = 85) had higher CRP and ESR than non-obese patients (n = 66) (p-values 0.008 and 0.000005, respectively). In addition, obese females with RA had significantly higher CRP and ESR as compared to non-obese females. However, the difference was not significant in males. Twenty-one obese (24.7%) and two non-obese RA patients (3%) had elevated CRP (difference of approximately 22% [24.7 minus 3]). Forty obese (47%) and 16 non-obese RA patients (24.2%) had elevated ESR (difference of approximately 23% [47 minus 24.2]). Thus, obesity was the attributable cause of falsely elevated CRP and ESR in 22% and 23% of patients, respectively.

About one-fifth of patients with RA, who are actually in low disease activity, may have elevated inflammatory markers, primarily because of obesity. Therefore, elevated CRP and ESR in obese patients with RA should be interpreted with caution because it may lead to unnecessary overtreatment.

Vallianou NG, Evangelopoulos AA, Panagiotakos DB, et al. Associations of acute-phase reactants with metabolic syndrome in middle-aged overweight or obese people. Med Sci Monit 2010; 16: CR56-60.
Aronson D, Bartha P, Zinder O, et al. Obesity is the major determinant of elevated C-reactive protein in subjects with the metabolic syndrome. Int J Obes Relat Metab Disord 2004; 28: 674-679, DOI: 10.1038/sj.ijo.0802609.
George MD, Giles JT, Katz PP, et al. Impact of Obesity and Adiposity on Inflammatory Markers in Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2017; 69: 1789-1798, DOI: 10.1002/acr.23229.
Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010; 62: 2569-2581, DOI: 10.1002/art.27584.
Aletaha D, Nell VPK, Stamm T, et al. Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther 2005; 7: R796-R806, DOI: 10.1186/ar1740.
Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal Obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009; 57: 163-170.
Pou KM, Massaro JM, Hoffmann, et al. Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: the Framingham Heart Study. Circulation 2007; 116: 1234-1241, DOI: 10.1161/CIRCULATIONAHA.107.710509.
Kapoor D, Clarke S, Stanworth R, et al. The effect of testosterone replacement therapy on adipocytokines and C-reactive protein in hypogonadal men with type 2 diabetes. Eur J Endocrinol 2007; 156: 595-602, DOI: 10.1530/EJE-06-0737.
Faam B, Zarkesh M, Daneshpour SM, et al. The association between inflammatory markers and obesity-related factors in Tehranian adults: Tehran lipid and glucose study. Iran J Basic Med Sci 2014; 17: 577-582.
Dessein PH, Norton GR, Woodiwiss AJ, et al. Independent role of conventional cardiovascular risk factors as predictors of C-reactive protein concentrations in rheumatoid arthritis. J Rheumatol 2007; 34: 681-688.
Giles JT, Bartlett SJ, Andersen R, et al. Association of body fat with C-reactive protein in rheumatoid arthritis. Arthritis Rheum 2008; 58: 2632-2641, DOI: 10.1002/art.23766.
Hammer HB, Kvien TK, Terslev L. Ultrasound of the hand is sufficient to detect subclinical inflammation in rheumatoid arthritis remission: a post hoc longitudinal study. Arthritis Res Ther 2017; 19: 221, DOI: 10.1186/s13075-017-1428-4.
Zhang H, Xu H, Chen S, Mao X. The application value of MRI in the diagnosis of subclinical inflammation in patients with rheumatoid arthritis in remission. J Orthop Surg Res 2018; 13: 164, DOI: 10.1186/s13018-018-0866-2.
Oeser A, Chung CP, Asanuma Y, et al. Obesity is an independent contributor to functional capacity and inflammation in systemic lupus erythematosus. Arthritis Rheum 2005; 52: 3651-3659, DOI: 10.1002/art.21400.
Liu Y, Hazlewood GS, Kaplan GG, et al. The Impact of Obesity on Remission and Disease Activity in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2017; 69: 157-165, DOI: 10.1002/acr.22932.
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