Open Access

High body mass index in rheumatoid arthritis: why we should promote physical activity

  • M. Hugo1,
  • N. Mehsen-Cetre1,
  • A. Pierreisnard1,
  • E. Pupier1,
  • B. Cherifi1,
  • T. Schaeverbeke1 and
  • V. Rigalleau1Email author
Arthritis Research & Therapy201719:2

https://doi.org/10.1186/s13075-016-1209-5

Published: 10 January 2017

We were interested in the recent publication of Albrecht et al. on body mass index (BMI) distribution in rheumatoid arthritis (RA) [1]. According to this analysis of three large cohorts, the majority of patients with RA are overweight [1]. Low remission rates and common metabolic syndrome indicate that the increasing BMI in RA should be treated, but weight loss may not be the solution as it has been linked to increased mortality [2]. Working on nutritional status in RA, we had the opportunity to compare the body composition analysis (DEXA) and physical activity levels recorded over 3 days with Actimeters (SenseWear Arm Bands, Body Media, Stanford, CA, USA) in overweight versus normal-weight patients. We feel that our results may help orientate management despite the obesity paradox in RA.

As depicted in Table 1, the main characteristics of the patients (age and gender) and their disease (duration, DAS28-ESR, and use of corticosteroids) were similar in the overweight and normal subjects. The rates of rheumatoid cachexia and osteopenia were dramatically reduced in overweight patients. Over the whole group, BMI were positively related to bone mass (r = +0.29, p < 0.05) and the rachis T scores (r = +0.36, p < 0.01). The overweight patients had lower levels of physical activity, and BMI was negatively related to these levels: metabolic equivalent tasks (METs) (r = –0.60, p < 0.001) and daily duration of physical activity (r = –0.41, p < 0.005).
Table 1

Characteristics of patients with rheumatoid arthritis and who were overweight or obese (N = 27) as compared to patients of normal weight (N = 29)

 

Normal weight

Overweight or obese

p

Gender (% men)

20%

21%

NS

Age (years)

56 ± 12

58 ± 9

NS

Duration of rheumatoid arthritis (years)

6.9 ± 8.3

7.2 ± 6.6

NS

DAS28-ESR

3.7 ± 1.7

4.1 ± 2.0

NS

Treated by corticosteroids (%)

65%

53%

NS

Nutritional status

 Body mass index (kg/m2)

22.1 ± 2.2

30.5 ± 6.9

<0.0001

 Fat (%)

32.1 ± 10.2

38.0 ± 8.2

<0.05

 Fat-free mass index (kg/m2)

15.2 ± 1.7

18.6 ± 2.7

<0.001

 Metabolic syndrome (%)

10.3%

39.3%

<0.05

 Rheumatoid cachexia (%)

34.5%

3.7%

<0.01

Bone status

 Bone mass (g)

1978 ± 365

2223 ± 398

<0.05

 Rachis T score

–1.1 ± 1.3

0.0 ± 1.4

<0.005

 Osteopenic, rachis (%)

66%

24%

<0.005

 Femoral neck, T score

–1.3 ± 1.2

–0.6 ± 1.2

<0.05

 Osteopenic, femoral (%)

74%

40%

<0.05

Actimetry

 Metabolic equivalent tasks

1.52 ± 0.32

1.24 ± 0.25

<0.005

 Duration of physical activity (min/day)

109 ± 99

59 ± 71

<0.05

DAS28-ESR Disease Activity Score in 28 joints-erythrocyte sedimentation rate, NS not significant

The body composition analysis of our overweight patients shows that some of their nutritional characteristics should be preserved by therapeutic intervention: less rheumatoid cachexia, that is known to reduce life expectancy, and less osteopenia, whereas the risk of fractures is doubled in RA [3]. The reduced levels of physical activity in overweight RA patients has been reported using questionnaires [4], but to our knowledge this has not yet been demonstrated with more objective actimetry measurements as we have performed. Improving these low levels of activity should be beneficial for the metabolic syndrome of overweight patients. Exercise is also considered beneficial for osteoporosis and for rheumatoid cachexia. The main limitation of interventions on physical activity is their modest results in terms of weight loss [5], while mortality may be increased by frank and unintentional weight loss in RA [2].

Notes

Abbreviations

BMI: 

Body mass index

MET: 

Metabolic equivalent task

RA: 

Rheumatoid arthritis

Declarations

Acknowledgements

We thank Dr. Simon Jarman, a retired member of our University, who checked the English language of the revised text.

Funding

None.

Availability of data and materials

Data are available from the Department of Endocrinology-Nutrition, CHU de Bordeaux; they cannot be shared at the moment as they are being used for the thesis of one of our students.

Authors’ contributions

MH and VR collected the data and wrote the paper. AP, TS, and NMC collected data and participated in the conception of the study. EP and BC participated in the analysis of the data. All authors read and approved the final manuscript.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

All the subjects provided written informed consent to participate to the study. The study was approved by the Comité de Protection des Personnes Sud-Ouest et Outre Mer III.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Endocrinologie-Nutrition, CHU de Bordeaux, USN, Hôpital Haut-Lévêque

References

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Copyright

© The Author(s). 2017

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