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Spondyloarthritis
Original research
Association of body mass index on disease activity in axial spondyloarthritis: systematic review and meta-analysis
  1. Jean W Liew1,
  2. Irvin J Huang1,
  3. Diana N Louden2,
  4. Namrata Singh1 and
  5. Lianne S Gensler3
  1. 1Medicine, Division of Rheumatology, University of Washington, Seattle, Washington, USA
  2. 2University Libraries, University of Washington, Seattle, Washington, USA
  3. 3Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Jean W Liew; liew.jw{at}gmail.com

Abstract

Objectives In axial spondyloarthritis (axSpA), higher body mass index (BMI) is associated with worse outcomes including response to biologics. Further clarity is needed on whether BMI is associated with disease activity overall, independent of treatment response. We performed a systematic review and meta-analysis to assess the association between BMI and disease activity as reported by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) or Ankylosing Spondylitis Disease Activity Score (ASDAS) in axSpA.

Methods We systematically searched for studies evaluating BMI and disease activity as the exposure and outcome of interest, respectively, in axSpA. Using random effects models, we estimated summary standardised mean differences (SMDs) and 95% CIs of BASDAI or ASDAS, comparing obese (BMI>30 kg/m2) or overweight/obese (BMI>25 kg/m2) individuals to those with normal BMI (18.5–24.9 kg/m2).

Results Twelve studies were included in the meta-analysis. Among all studies reporting the BASDAI at baseline, the pooled SMD of the BASDAI for those with an obese or overweight/obese BMI compared to a normal BMI was 0.38 (95% CI 0.21 to 0.55, I2 =75.2%), indicating a significant association of higher BMI with higher BASDAI score. The pooled SMD of the ASDAS for those with an obese or overweight/obese BMI compared to a normal BMI was 0.40 (95% CI 0.27 to 0.54, I2=0%). Findings were robust across subgroup analyses.

Conclusion These results demonstrate an association between an overweight/obese BMI and higher disease activity in studies of axSpA. Future longitudinal studies of BMI and disease activity should assess how this association changes over time.

  • Ankylosing spondylitis
  • Disease activity
  • Epidemiology
  • Outcomes research
  • Adalimumab
  • Rheumatoid arthritis
  • Autoimmune diseases
  • Spondyloarthritis
  • Arthritis
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/rmdopen-2020-001225

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    Footnotes

    • Twitter Jean Liew @rheum_cat and Irvin Huang @Irvin_Huang

    • Contributors JWL substantially contributed to the conception and design of the work, and the acquisition, analysis and interpretation of data; involved in drafting the work and revising it critically for important intellectual content; provided final approval of the version to be published. IJH substantially contributed to the acquisition, analysis and interpretation of data for the work; involved in revising the work critically for important intellectual content; provided final approval of the version to be published. DNL substantially contributed to the conception and design of the work, and the acquisition of data for the work; involved in revising the work critically for important intellectual content; provided final approval of the version to be published. NS substantially contributed to the conception and design of the work, and the analysis and interpretation of data; involved in revising the work critically for important intellectual content; provided final approval of the version to be published. LSG substantially contributed to the conception and design of the work, and the interpretation of data; involved in revising the work critically for important intellectual content; provided final approval of the version to be published.

    • Funding JWL: NIH T32 training grant (T32AR007108) and funding from the Assessment of Spondyloarthritis Society (ASAS) and the Spondyloarthritis Research and Treatment Network (SPARTAN); NS: Rheumatology Research Foundation and American Heart Association; LSG: Spondylitis Association of America and the Russel Engelman Rheumatology Research Center at the University of California, San Francisco.

    • Competing interests LSG: Consulting for AbbVie, GSK, Eli Lilly, Novartis, Pfizer and UCB (under $10 000); Grant/research support from UCB, Novartis, Pfizer;

      All others: None.

    • Patient consent for publication Not required.

    • Data sharing statement Data are available upon reasonable request.

    • Provenance and peer review Not commissioned; externally peer reviewed.