People with rheumatoid arthritis  taking biologics are less likely to reach clinical remission but also less likely to have radiographic damage if they are obese, a systematic review presented here in Madrid shows.

Presenting the findings to congress during the clinical session RA: really a systemic disease? Ms Vera de Jonge from the VU University Medical Centre in Amsterdam said the discovery had implications for the optimal use of biologic agents in patients with RA with different BMI scores.

The review involving 12 studies and 3,674 RA patients found that higher BMI was associated with poor response, based on either outcome or percentages on remission or improvement defined according to EULAR guidelines.

Four of the studies revealed that higher BMI was also associated with higher Health Assessment Questionnaire (HAQ)-scores.

Two studies focusing on the relationship between BMI and joint destruction showed that higher BMI values were associated with lower odds for having joint destruction.

One study also showed that being underweight (BMI < 20 kg/m² ) was associated with a higher odds ratio (OR = 4.12) for joint destruction.

Ms Jonge told the conference that the mechanisms behind the somewhat paradoxical findings were unclear but could be related to a high presence of pro-inflammatory cytokines, pharmacokinetics or higher VAS scores in obese patients.

“We have to look for optimal dose regimes for biological DMARDs in RA patients to find the balance between clinical remission and radiographic joint destruction,” she told delegates.

You can view study abstract here.