Obesity and reduction of the response rate to anti-tumor necrosis factor α in rheumatoid arthritis: An approach to a personalized medicine

Elisa Gremese, Antonio Carletto, Melissa Padovan, Fabiola Atzeni, Bernd Raffeiner, Anna Rita Giardina, Ennio Giulio Favalli, Gian Luca Erre, Roberto Gorla, Mauro Galeazzi, Rosario Foti, Fabrizio Cantini, Carlo Salvarani, Ignazio Olivieri, Giovanni Lapadula, Gianfranco Ferraccioli

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Abstract

Objective Obesity is a mild, long-lasting inflammatory disease and, as such, could increase the inflammatory burden of rheumatoid arthritis (RA). The study aim was to determine whether obesity represents a risk factor for a poor remission rate in RA patients requiring anti-tumor necrosis factor α (anti-TNFα) therapy for progressive and active disease despite treatment with methotrexate or other disease-modifying antirheumatic drugs. Methods Patients were identified from 15 outpatient clinics of university hospitals and hospitals in Italy taking part in the Gruppo Italiano di Studio sulle Early Arthritis network. Disease Activity Score in 28 joints (DAS28), body mass index (BMI; categorized as 30 kg/m2), acute-phase reactants, IgM rheumatoid factor, and anti-cyclic citrullinated peptide antibody values were collected. DAS28 remission was defined as a score of 30 kg/m2 was recorded in 66 (10.3%) of 641 RA patients. After 12 months of anti-TNFα treatment, a DAS28 of 2, and in 32.9% of the patients with a BMI of 2 (P = 0.01). The lowest percentage of remission, which was statistically significant versus adalimumab and etanercept (P = 0.003), was observed with infliximab. Conclusion Obesity represents a risk factor for a poor remission rate in patients with longstanding RA treated with anti-TNFα agents. A personalized treatment plan might be a possible solution.

Original languageEnglish
Pages (from-to)94-100
Number of pages7
JournalArthritis Care and Research
Volume65
Issue number1
DOIs
Publication statusPublished - Jan 2013

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ASJC Scopus subject areas

  • Rheumatology

Cite this

Gremese, E., Carletto, A., Padovan, M., Atzeni, F., Raffeiner, B., Giardina, A. R., Favalli, E. G., Erre, G. L., Gorla, R., Galeazzi, M., Foti, R., Cantini, F., Salvarani, C., Olivieri, I., Lapadula, G., & Ferraccioli, G. (2013). Obesity and reduction of the response rate to anti-tumor necrosis factor α in rheumatoid arthritis: An approach to a personalized medicine. Arthritis Care and Research, 65(1), 94-100. https://doi.org/10.1002/acr.21768