RA Patients Who Smoke, Are Overweight Fare Worse

Multiple sites and more than 1, 100 patients confirm it…rheumatoid arthritis (RA) patients who smoke or are overweight have extra trouble controlling their symptoms and inflammation, despite standard of care treatment.

“Early, aggressive treatment to achieve remission is the primary goal of therapy and can be best achieved early on when treating patients with newly diagnosed rheumatoid arthritis, as early disease control is associated with improved long-term outcomes, ” said Vivian P. Bykerk, M.D., senior investigator and director of the Inflammatory Arthritis Center of Excellence at Hospital for Special Surgery, in the November 15, 2016 news release. “We have previously shown that individuals with excess weight are less likely to achieve sustained remission in the first three years after diagnosis. Here we explore the impact of smoking and being overweight or obese on the ability to achieve good control of symptoms and inflammation in men and women with rheumatoid arthritis.”

According to the news release, “Data were collected at 19 sites across Canada as part of the CATCH (Canadian Early Arthritis Cohort) Study. The multicenter study included rheumatoid arthritis patients diagnosed within 12 months of symptom onset. Researchers looked at the patient’s disease activity score, known as the DAS, when they entered the study and at follow-up visits. The DAS is based on the number of swollen and tender joints, a blood test that reflects inflammation, and the patient’s own description of their arthritis symptoms over the prior week.”

Dr. Bykerk told OTW, “RA patients’ sex, excess weight and smoking were not significantly associated with symptom severity early on, when patients entered the study. However, all three factors influenced how much symptoms improved over time.”

“The average rate of improvement in the disease activity score was lower in women compared to men. Less symptom improvement was also seen in patients who were overweight or obese compared with those of a healthy weight. Current smokers also saw less symptom relief compared to nonsmokers over time. Former smokers, however, did not do worse than those who had never smoked. The most dramatic differences in symptoms were seen in patients who were overweight or obese and smoked. These patients had considerably worse outcomes over time compared to nonsmoking patients with a healthy weight.”

“Orthopedic surgeons are often the first line of care for patients and can recognize rheumatoid arthritis. This is an opportunity for orthopedic surgeons to initiate a team approach to care by referring the patient to a rheumatologist, with the goal of improving outcomes. In addition to prescribing the appropriate medication, the rheumatologist can help patients with lifestyle changes that could lead to symptom improvement. Rheumatoid arthritis is a destructive disease, but, as our study demonstrated, excess weight and smoking played a role in symptom improvement when patients received standard-of-care treatment in the form of oral medication.”