Details

Autor(en) / Beteiligte

• Scott, Ian C
• Bajpai, Ram
• Hider, Samantha L
• Helliwell, Toby
• Muller, Sara
• Mallen, Christian D

Titel

O38 The relationship between obesity and outcomes in patients with polymyalgia rheumatica

Ist Teil von

• Rheumatology (Oxford, England), 2020-04, Vol.59 (Supplement_2)

Ort / Verlag

Oxford University Press

Erscheinungsjahr

2020

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Abstract Background 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. Methods 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. Results 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). O38 Table 1 Predicted mean outcomes by BMI category from Multivariable Models (* indicates P<0.05) Outcome Time Normal/Underweight Overweight P-value Obese P-value Pain Baseline 7.59 (7.32-7.86) 7.89 (7.65-8.13) 0.102 7.98 (7.67-8.28) 0.066 12 months 2.41 (2.05-2.77) 2.72 (2.41-3.03) 0.197 3.46 (3.08-3.84) 0.000* 24 months 2.51 (2.07-2.96) 2.92 (2.52-3.32) 0.173 3.15 (2.66-3.65) 0.059 Stiffness Baseline 7.56 (7.28-7.84) 7.60 (7.34-7.85) 0.856 7.64 (7.32-7.95) 0.735 12 months 2.59 (2.21-2.96) 2.98 (2.65-3.31) 0.113 3.86 (3.46-4.25) 0.000* 24 months 2.78 (2.32-3.23) 3.17 (2.75-3.58) 0.205 3.50 (2.99-4.01) 0.038* PHQ8 Baseline 5.89 (5.22-6.56) 5.45 (4.85-6.04) 0.298 6.62 (5.86-7.39) 0.154 12 months 4.23 (3.48-4.98) 4.24 (3.58-4.90) 0.975 5.32 (4.54-6.09) 0.043* 24 months 3.93 (3.15-4.70) 4.44 (3.75-5.12) 0.298 5.42 (4.56-6.29) 0.010* GAD7 Baseline 4.23 (3.64-4.82) 3.97 (3.44-4.51) 0.500 4.26 (3.59-4.93) 0.941 12 months 3.58 (2.90-4.25) 3.55 (2.95-4.14) 0.940 3.40 (2.7-4.11) 0.719 24 months 3.05 (2.33-3.77) 3.80 (3.16-4.44) 0.101 3.48 (2.69-4.27) 0.421 FACIT-F Fatigue Baseline 34.5 (33.1-35.9) 34.5 (33.2-35.8) 0.993 31.9 (30.3-33.5) 0.017* 12 months 37.5 (35.9-39.1) 36.2 (34.8-37.6) 0.179 33.8 (32.2-35.5) 0.001* 24 months 37.4 (35.8-39.1) 36.3 (34.8-37.8) 0.284 33.5 (31.7-35.4) 0.002* mHAQ Baseline 0.52 (0.45-0.59) 0.58 (0.52-0.64) 0.180 0.62 (0.55-0.70) 0.054 12 months 0.33 (0.25-0.41) 0.38 (0.31-0.44) 0.369 0.58 (0.50-0.66) 0.000* 24 months 0.36 (0.28-0.44) 0.48 (0.41-0.55) 0.020* 0.54 (0.45-0.63) 0.003* EQ-5D-3L Baseline 0.70 (0.67-0.74) 0.69 (0.66-0.72) 0.457 0.61 (0.57-0.65) 0.001* 12 months 0.73 (0.69-0.77) 0.70 (0.67-0.74) 0.316 0.62 (0.58-0.66) 0.000* 24 months 0.69 (0.65-0.74) 0.68 (0.64-0.71) 0.540 0.64 (0.59-0.68) 0.079 Conclusion 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. Disclosures I.C. Scott None. R. Bajpai None. S.L. Hider None. T. Helliwell None. S. Muller None. C.D. Mallen None.