Association Of Weight Loss With Improved Disease Activity In Patients With Rheumatoid Arthritis: A Retrospective Analysis Using Electronic Medical Record Data
David J. Kreps1, Florencia Halperin2,3, Sonali P. Desai1,2, Zhi Z. Zhang1, Elena Losina2,4, Amber T. Olson1, Elizabeth W. Karlson1,2, Bonnie L. Bermas5& Jeffrey A. Sparks1,2*
1Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Womens Hospital, Boston, MA, USA
2Harvard Medical School, Boston, MA, USA
3Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Womens Hospital, Boston, MA, USA
4Department of Orthopedic Surgery, Brigham and Womens Hospital, Boston, MA, USA
5University of Texas Southwestern Medical Center, Dallas, TX, USA
- *Corresponding Author:
- Brigham and Womens HospitalBoston, MA, USA
Take Note Of All Your Meals Snacks And Beverages
Many weight loss experts recommend keeping a food diary. It helps to write down everything you eat including how much and when and review it carefully you could be eating much more than you realize, which could explain why the bathroom scale isnt moving. As you write in your food diary, be honest with yourself. A food diary is also helpful in tracking foods that may lead to flare-ups of your symptoms. Also, if you decide to work with a nutritionist, a diet journal could be a good starting point.
Weight Loss May Predict Early Death In Ra Patients
Published in May in Arthritis & Rheumatology, the report, Weight loss, the obesity paradox and the risk of death in rheumatoid arthritis, found that, although lower body mass index is associated with improved outcomes in the general population, it has been associated with premature death in patients with rheumatoid arthritis . As the first study to comprehensively look at the role of weight loss over time in predicting death in patients with RA, it helps explain this obesity paradox, in which weight lossnot low BMI, per seis a strong predictor of mortality.
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What our study tried to do is take a step further and figure out why that is and get at the idea that perhaps this is all due to confounding by disease-related weight loss, says lead author Joshua Baker, MD, MSCE, a rheumatologist at the University Hospital of the University of Pennsylvania in Philadelphia. This confounding really causes you to underestimate the risks of obesity.
The report, which used data from the Department of Veterans Affairs, found that a loss in BMI greater than or equal to 1 kg/m2 was associated with a greater risk of death after adjusting for demographics, comorbidities, BMI, smoking and RA therapies . Weight loss at an annualized rate of greater than or equal to 3 kg/m2 was associated with the greatest risk of death .1
Richard Quinn is a freelance writer in New Jersey.
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Easing Sudden Weight Loss
Its important to remember that gradual, intentional weight loss is not the same as sudden weight loss caused by rheumatoid sarcopenia and cachexia . Sudden weight loss and other symptoms of rheumatoid cachexia can be eased through the use of tumor necrosis factor inhibitors which reduce inflammation and high-intensity strength training, which improves muscle strength and physical functioning.
Would My Oa Patient Benefit From Losing Weight
Weight/Height Tables. Determining whether a patient would benefit from weight loss involves making some informed decisions. One method that offers general guidelines is to determine whether a patients weight falls into the healthy weight ranges currently recommended for adults. These ranges, which were revised and updated in 1995, are presented in the Optimal Weight/Height Table below. In general, within each range the lower weights are for women, while the higher weights are for men.
Federal Guidelines on Obesity The first Federal Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults were released in March, 1998 by the National Heart, Lung, and Blood Institute , in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases . These guidelines proposed that health care providers use three measures to assess overweight: body mass index waist circumference, and patients risk factors for diseases and conditions associated with obesity.
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Talking To Arthritis Patients About Weight Loss
Weight loss eases arthritis pain and improves the quality of life of adults living with arthritis, especially if they are overweight or have obesity.
More than 58 million US adults have arthritis. Among adults with arthritis, 39 million are overweight or have obesity.
Healthcare professionals can counsel their arthritis patients to lose weight if they are overweight or have obesity. Research suggests that patients who receive weight counseling from a healthcare professional are almost 4 times more likely to attempt weight loss than those not receiving counseling. Adults with arthritis can decrease pain and improve function by being at a healthy weight. Weight loss is a non-drug way to manage arthritis and ease joint pain.
Combined Analysis Of Women With Ra And Matched Comparators
Figure 3 displays the multivariable HRs for the combined analysis of RA and matched comparators with stable weight comparators as the reference group. In this analysis, the 95%CIs were wide at the extreme weight change categories due to low sample size, particularly for women with RA. Women with RA had higher HR for mortality than comparators in every weight change category. The highest HR for mortality for both RA and comparators was in the severe weight loss category. Women with RA and severe weight loss in the peri-RA period had HR for mortality of 2.92 compared to comparators with stable weight. Comparators with severe weight loss had HR for mortality of 2.21 compared to comparators with stable weight. There was no statistical interaction for RA/comparator status and weight change category for mortality .
Multivariable hazard ratios for mortality according to peri-RA or peri-index weight change, combining the RA and comparison cohorts into a single analysis .
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Mortality In The Comparison Cohort By Weight Change In The Peri
In the age- and BMI-adjusted analysis performed only among matched comparators, there were statistically significant associations between both weight loss and weight gain in the peri-index period for subsequent mortality compared to stable weight . However, when further adjusting for smoking, physical activity, diet quality, income, and multimorbidities, only severe and moderate weight loss remained significantly associated with mortality. Severe loss in the peri-RA period had HR for subsequent mortality of 2.16 in the multivariable model.
Figure 2B displays the Kaplan-Meier curves for matched comparators for death-free survival after the end of the early index period. The survival curves according to weight change categories were statistically different for comparators . Similar to the RA Kaplan-Meier curves, the comparator survival curves for stable weight and weight gain categories were overlapping, while weight loss categories showed a graded effect across severity of weight loss. The median survival for comparators with severe weight loss was 8.8 years . Women with stable weight had median survival of 17.9 years after the end of the early index period. Comparators had longer survival than women with RA in all analogous weight change categories.
How Your Weight Affects Inflammation
Cytokine levels are already high when you have inflammatory arthritis obesity takes it up a notch. In fact, a research review of 329 studies found that obesity can lead to more active and severe rheumatoid arthritis and psoriatic arthritis.
Extra weight also places increased pressure and stress on the joints, which can worsen the pain and stiffness associated with inflammatory arthritis, says Dr. Andrews. Plus, obesity may also impact how well your meds work. One study published in the journal Arthritis Care & Research showed regardless of the type of initial treatment, people with RA who were overweight or obese were significantly less likely to achieve sustained remission, compared to those with a healthy BMI.
The basics to losing weight apply to everyone, whether you have arthritis or not: Eat a variety of fruits and veggies and choose whole grains, low-fat dairy, and lean protein. Watch your portions, have regular, balanced meals, and of course, exercise more.
One Brenda keeps her advice simple and to the point: Eat whole fresh foods! Get rid of the processed crap!
Here are 12 more tips to help you shed unwanted pounds and help your joints feel better:
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Mortality Rates After The Early Ra Or Matched Index Period
In the RA cohort, there were 371 deaths during 16,007 person-years of follow-up after the early RA period years, Table 3). In the comparison cohort, there were 2,303 deaths during 150,074 person-years of follow-up after the early index period years). The RA cohort had higher absolute mortality rate across all weight change categories than comparators .
What Causes Unintended Weight Gain In Rheumatoid Arthritis
While the disease itself doesnt cause you to pack on pounds, RA disrupts your body and routine in a number of ways that could result in weight gain. Its difficult to predict how each patient will adapt and react to their RA, but there are some clear factors that will increase your chances of struggling with unwanted rheumatoid arthritis weight gain:
Medication
Not all medications will interfere with your metabolism, but the corticosteroid prednisone has a particularly bad reputation when it comes to weight gain. It also happens to be one of the most commonly prescribed drugs for the chronic inflammation of RA.
Unfortunately, the majority of patients who take prednisone will experience some degree of weight gain and sometimes in places you dont expect. Fat can accumulate in the face, abdomen and even the back of the neck. Fortunately, most people will quickly shed the excess weight once the steroid dosage is lowered.
Exercise Problems
Its no secret that exercise is one of the very best things you can do for your muscles, joints, and waistline, but it can get complicated when RA flares up. You may realize that an exercise class or long walk is best for your body in the long run, but simply getting off the couch and out of the front door can be too much to ask some days.
Diet Issues
Once you factor in unwelcome medication side effects and a less active lifestyle, youll find that your regular diet may no longer be suitable.
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Study On Weight Loss Counseling Arthritis Patients
A CDC study found that healthcare professionals counseling for weight loss for adults with arthritis who are overweight or have obesity increased from approximately 35% in 2002 to 46% in 2014. Still, more than half of adults who have arthritis and weigh more than recommended are not receiving healthcare professional counseling to lose weight.
Healthcare professionals should talk to their patients about physical activity and nutrition options to lose weight and maintain a healthy weight.
A healthcare professional can talk to a patient with arthritis about weight loss options.
Excess Weight Can Make Inflammatory Arthritis Even Worse This Advice Can Help You Shed Unwanted Pounds And Make Your Joints Feel Better Too
Dropping extra pounds can be tough enough. Add some stiff, achy joints and extra dose of fatigue to the task, and it may feel near impossible.
But with some effort, you can slim down, and heres why its important: Excess weight can make inflammatory arthritis even worse. Fat tissue releases proteins called cytokines, which cause inflammation in the body, explains Caroline A. Andrews, MD, medical weight management specialist at the Hospital for Special Surgery in New York City. The role of weight loss is one of many things your doctor might not tell you about managing arthritis.
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Healthcare Professionals: Tips To Improve Your Arthritis Patients Health
- Enroll in proven programs. Adults living with joint pain can benefit from joining CDC-recognized self-management education classes, which are designed to teach people with arthritis and other chronic conditions how to control their symptoms , live well with these conditions, and learn more about how to manage health problems that affect their lives.
The Role Of Rheumatoid Sarcopenia
An explanation of the obesity paradox may be found in the progression of RA specifically, the development of a condition called rheumatoid sarcopenia. In rheumatoid sarcopenia, chronic inflammation leads to metabolic hyperactivity, which causes the body to shed muscle mass and may cause visible signs of muscle wasting. Meanwhile, fat might replace the remaining muscle.
Some people in this situation dont see any weight changes because the fat theyve gained balances out the lost muscle. However, weight loss can also be a sign of metabolic hyperactivity, according to Dr. Navarro-Millán: Some people with RA are not doing any intentional weight loss program but find that theyre losing weight.
Therefore, the obesity paradox may actually result from people with RA and a high BMI suddenly losing weight due to other factors which may also trigger severe health events.
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Does Rheumatoid Arthritis Cause Weight Loss
CreakyJoints reports on the association between rheumatoid arthritis and weight.
CreakyJoints spoke to Caroline A. Andrew, MD, medical weight management specialist at HSS, who explained RA can decrease your appetite, and aches and pains can be a factor as well. If a person has significant joint pain and cannot move easily or exercise, there may be a loss of muscle mass, causing weight loss, said Dr. Andrew. If RA symptoms improve with treatment, a person can start to do physical therapy and exercise and start to regain muscle mass. Appetite may also improve, added Dr. Andrew.
Being overweight with RA is also concerning. Dr. Andrew detailed, Carrying extra weight places increased pressure and stress on the joints, which can worsen the pain and stiffness associated with RA. Every pound of excess weight places about four pounds of extra pressure on the knees. Furthermore, Dr. Andrew concluded, Studies have shown that some DMARDs may not be as effective in subjects who are overweight or obese. One study showed that regardless of the type of initial treatment, subjects with RA who were overweight or obese were significantly less likely to achieve sustained remission compared to subjects with a normal weight.
Read the full article at CreakyJoints.org.
What Is Rheumatoid Arthritis
Rheumatoid arthritis is, in a word, painful. It is a disease in which the immune system seems to have gone haywire. Instead of doing its normal job of attacking invaders like bacteria and viruses, it begins attacking the bodys own joints.
The result is severe inflammation. Hands, wrists, elbows, knees, and ankles suffer. Often, so do other parts of the body, from eyes to skin.
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Continue Learning About Rheumatoid Arthritis
Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.
What Are The Symptoms Of Rheumatoid Cachexia
Your RA symptoms might get worse. You could also notice muscle weakness and find that itâs harder to perform everyday tasks. Your doctor might also tell you that you have:
A higher resting energy expenditure . This is the energy or calories you use during 24 hours when you arenât active.
Quicker whole-body protein catabolism. This means your body is breaking protein down into amino acids faster than it did before.
Higher levels of inflammatory cytokines , which are part of your immune response. Tumor necrosis factor-alpha not only causes inflammation, it also helps coordinate the process. Interleukin-1beta plays a role in controlling inflammation too, and can make joint damage worse when you have a disease like RA.
Sarcopenia. This syndrome results in a loss of skeletal muscle mass and strength. It puts you more at risk for a poor quality of life, physical disability, and death. Rheumatoid cachexia may explain why so many people with RA have sarcopenia.
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Causes Of Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease. This means your immune system attacks the cells that line your joints by mistake, making the joints swollen, stiff and painful.
Over time, this can damage the joints, cartilage and nearby bone.
It’s not clear what triggers this problem with the immune system, although you’re at an increased risk if:
- you are a woman
- you have a family history of rheumatoid arthritis
Find out more about the causes of rheumatoid arthritis.
Best Foods For Arthritis That Help You Lose Weight
Losing weight is a good thing for people with arthritis, even if theyre not obese or considered overweight, since losing just a couple of pounds can take a significant burden off the weight-bearing joints.
In fact, studies show for every pound lost, the result is 4 pounds of strain taken off the knees. Plus, if you lose a few extra pounds , youre not only helping to reduce arthritis pain, you are also decreasing inflammation in the body since too much body fat increases inflammation.
Also, something to consider: if you take off excess weight, there may be other unexpected benefitsfor instance, you may not need to take pain medications for your arthritis as often or you might begin to sleep better because you have less joint pain.
Best Foods for Arthritis
What are some of the best foods for arthritis? Here are tips for choosing foods that will strengthen and protect your joints as well as support weight loss.
1. Choose Calcium-Rich Foods: To maintain healthy bones and joints, you need calcium, magnesium and vitamin D. Choose foods that contain high levels of these nutrients such as:
- Lowfat milk, cheese and yogurt
- Milk alternatives enriched with calcium, such as soy and rice
- Canned salmon and sardines
- Chard and other leafy greens
Foods to Avoid with Arthritis
It is also important to avoid foods that dont nourish your joints. Foods to avoid with arthritis include highly processed foods, refined sugar and foods made with white flour, such as pasta or baked goods.
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