Scott, IC, Bajpai, R, Hider, SL, Helliwell, T, Muller, SN and Mallen, C (2020) The relationship between obesity and outcomes in patients with polymyalgia rheumatica. Rheumatology, 59 (2). ISSN 1462-0332

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Obesity predisposes to a pro-inflammatory state. Studies have reported worse clinical outcomes in patients with inflammatory arthritis who are obese. The relationship between obesity and outcomes in patients with polymyalgia rheumatica (PMR), another common inflammatory rheumatic condition, has not been assessed. We examined this in a cohort study of primary care-recruited patients with PMR.

The PMR Cohort Study is an inception cohort of patients with incident PMR, recruited from 382 general practices. Self-completed questionnaires at 0, 12, and 24-months captured: (a) PMR-related pain (0-10 numeric rating scale [NRS]); (b) PMR-related stiffness (0-10 NRS); (c) anxiety (GAD7); (d) depression (PHQ8); (e) fatigue (FACIT-Fatigue); (f) function (mHAQ); (g) quality of life (EQ-5D-3L). Height was self-reported at baseline, and weight at baseline, 12 and 24 months. Patients were categorised as underweight (BMI<18.5 kg/m2); normal weight (18.50-24.99 kg/m2); overweight (25-29.99 kg/m2); or obese (≥30 kg/m2). Piecewise, multivariable, multilevel, linear mixed-effects regression models examined relationships between BMI categories and outcomes over time, using restricted cubic spline functions. Adjustments were made for age, sex, prednisolone-use, smoking, and alcohol. Due to few underweight patients (three at 0 months; one at 12/24 months), underweight and normal weight patients were combined, as a single reference group.

652 patients were included (62% female). At baseline, mean age was 72 years, median BMI 26.6 (IQR 24.0-30.2), 34% were normal/under-weight, 40% overweight, and 26% obese. Compared to normal/underweight patients, obese patients had the following significantly poorer outcomes (P<0.05): higher pain scores at 12-months; higher stiffness scores at 12 and 24 months; higher depression levels at 12 and 24 months; worse fatigue at 0, 12 and 24 months; worse function at 12 and 24 months; worse quality of life at 0, and 12 months. BMI changed little over 24 months (25.7% and 25.9% obese at 0 and 24-months, respectively).

Obesity is associated with poorer outcomes in patients with PMR. Consideration should be given to providing weight management support to patients with PMR and obesity. Further research should examine the impacts of weight-based steroid dosing on outcomes.

Item Type: Article
Additional Information: The final version of this article with all relevant information can be found at;
Subjects: Q Science > Q Science (General)
R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
R Medicine > RC Internal medicine > RC927 Rheumatism
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Depositing User: Symplectic
Date Deposited: 17 Jun 2020 08:23
Last Modified: 09 Jul 2020 10:16

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