The likelihood of achieving sustained remission in early rheumatoid arthritis (ERA) is significantly lower in patients who smoke and who are obese. Moreover, these potential modifiable lifestyle factors have a high prevalence in patients with ERA. These data were presented during an oral abstract session at the EULAR Annual Congress 2016 in London.
EULAR recommendations state that remission (absent disease activity) is the target of treatment in patients with rheumatoid arthritis (RA). Although newer medication can be highly effective, many patients fail to achieve or maintain remission. Within ten years of onset, at least 50% of patients in developed countries are unable to maintain a full-time job.
‘Relatively little is known about whether and to what extent modifiable lifestyle factors such as excess weight and smoking impact the likelihood of achieving sustained remission in RA’, said Dr. Susan Bartlett (McGill University, Montreal). ‘To explore the independent and combined effects of excess weight and smoking on achieving sustained remission in early RA, we examined the first 3 years of data of 1008 ERA patients enrolled in the Canadian Early Arthritis Cohort.’
Canadian Early Arthritis Cohort (CATCH) is a multicentre prospective cohort study in which patients receive usual care. Participants met 1987 or 2010 ACR/EULAR criteria for RA, had less than 12 months of symptom duration, were not in remission at entry, and had BMI and at least 2 consecutive DAS28 scores available. Sustained remission was defined as DAS28 Among male patients, just under one half were overweight, one third obese, and one fifth smoked. Among female patients, just under one third were overweight, one third obese, and 15% smoked. At entry, 741 (74%) patients were treated with MTX (mono or combination therapy), relatively few 28 (3%) with a biologic, and 522 (52%) with steroids. The proportion in sustained remission rose steadily; at 3 years 408 (38%) had achieved sustained remission with a median time to sustained remission of 11.3 months.
‘Both smoking status and BMI class were independently associated with the likelihood of treatment success, as was gender’, summarizes Dr. Bartlett. ‘A non-smoking male with a healthy BMI and would have a 41% probability of achieving sustained remission within 3 years versus only 15% for an obese male smoker. A non-smoking female with a healthy BMI would have a 27% probability of achieving sustained remission within 3 years versus only 10% for an obese female smoker.’
‘So our findings in a large real-world cohort show that not smoking and a healthy body weight can have a significant impact on becoming symptom-free. Therefore, these findings suggest that its is worth to encourage patients to stop smoking and to achieve a healthy body. Changing your lifestyle, it is very difficult but our data suggest, that every pound you loose can make a difference. So even if you loose only 3-5 kg it might be beneficial.’
ASCO Annual Meeting 2016