Skip to main content

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

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)

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].

Abbreviations

BMI:

Body mass index

MET:

Metabolic equivalent task

RA:

Rheumatoid arthritis

References

  1. 1.

    Albrecht K, Richter A, Callhoff J, Huscher D, Schett G, Strangfeld A, Zink A. Body mass index distribution in rheumatoid arthritis: a collaborative analysis from three large German rheumatoid arthritis databases. Arthritis Res Ther. 2016;23(18):149. doi:10.1186/s13075-016-1043-9.

  2. 2.

    Baker JF, Billig E, Michaud K, Ibrahim S, Caplan L, Cannon GW, et al. Weight loss, the obesity paradox, and the risk of death in rheumatoid arthritis. Arthritis Rheumatol. 2015;67(7):1711–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    van Staa TP, Geusens P, Bijlsma JW, et al. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum. 2006;54(10):3104–12.

    Article  PubMed  Google Scholar 

  4. 4.

    Stavropoulos-Kalinoglou A, Metsios GS, Smith JP, Panoulas VF, Douglas KMJ, Jamurtas AZ, et al. What predicts obesity in patients with rheumatoid arthritis ? An investigation of the interactions between lifestyle and inflammation. Int J Obesity. 2010;34:295–301.

    CAS  Article  Google Scholar 

  5. 5.

    Cai X, Qiu SH, Yin H, Sun ZL, Ju CP, Zügel M, et al. Pedometer intervention and weight loss in overweight and obese adults with type 2 diabetes: a meta-analysis. Diabet Med. 2016;33(8):1035–44.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to V. Rigalleau.

Additional information

See related research by Albrecht et al., http://arthritis-research.biomedcentral.com/articles/10.1186/s13075-016-1043-9

Rights and permissions

Open Access This 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.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hugo, M., Mehsen-Cetre, N., Pierreisnard, A. et al. High body mass index in rheumatoid arthritis: why we should promote physical activity. Arthritis Res Ther 19, 2 (2017). https://doi.org/10.1186/s13075-016-1209-5

Download citation

Keywords

  • Physical Activity
  • Body Mass Index
  • Rheumatoid Arthritis
  • Metabolic Syndrome
  • Rheumatoid Arthritis Patient