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Obese Polymyalgia Rheumatica Patients Experience More Pain and Disability and Need Higher Doses Of Glucocorticoids

Abstract:
#1663
Presenter:
Cimmino, Marco A. MD
Co-Authors:
Dasgupta, Bhaskar FRCP, MD; Crowson, Cynthia S. MS; Schirmer, Michael MD; Dejaco, Christian MD, PhD; Salvarani, Carlo MD; Matteson, Eric L. MD, MPH
Date:
Monday, October 28, 2013
Presenter Available:
9:00 am - 11:00 am
Poster Available:
8:30 am - 4:00 pm
Location:
Exhibit Hall B2-C-D
Session Title:
Vasculitis II
Abstract Category:
Vasculitis
Type:
Poster
Description:

Background/Purpose:

Obesity is not only a risk factor for osteoarthritis but also for rheumatoid arthritis (RA). In obese RA patients, disease incidence is higher and response to treatment poorer. This paper is concerned with an evaluation of the clinical characteristics at onset and of the outcome of polymyalgia rheumatica (PMR) in obese vs. non-obese patients.

Methods:

83 patients with newly diagnosed PMR from the clinical cohort studied to obtain the ACR/EULAR criteria were studied. Weight and height were obtained and the BMI calculated. Obesity was defined as a BMI≥30 kg/m2.

Results:

The mean BMI was 26.1± 3.4, with BMI ≥ 30 found in 12 patients (14.5%). The two groups were comparable in terms of age (71.6±10.5 vs 72.6±8.1 years; p=0.53), sex (59% and 58% women, respectively; p=0.96), duration of morning stiffness (190±200 vs 206±219 minutes; p=0.42), and localization of involvement. Obese patients had a higher shoulder VAS (76.6±26.1 vs  58.8±25.5; p=0.03), global pain VAS (76.4±23.7 vs  58.7±24.9; p=0.025), PMR VAS (82.3±21.9 vs  60.6±24.3; p=0.004), fatigue VAS (71.8±28.1 vs  53.7±27.2; p=0.03), and modified HAQ (1.7±0.6 vs  1.2±0.6; p=0.005). They also showed a decreased physical component of the SF36 (31.6±6.3 vs 35.7±7.1; p=0.048).

The mean dose of prednisone was not different at treatment onset between obese (16.6±7 mg) and non-obese (15.1±5.6 mg) patients (p=0.98). At the end of follow-up, the clinical and laboratory features of both obese and non-obese patients significantly improved. However, during the first 6 months of treatment obese patients needed a higher mean daily dose of prednisone in comparison with the non obese ones (8.5±3.2 mg vs 6.2±5.2 mg; p=0.021). BMI was negatively correlated with percent improvement of PMR VAS at 6 months (Spearman r= -0.24; p=0.046), indicating that higher BMI was associated with a lower percent improvement. 

Conclusion:

Our results support the view that the burden of PMR is higher in obese vs. non obese patients. This fact may be related to the poorer quality of life seen usually in obese individuals as well as to the increased amount of cytokines produced by the adipose tissue. However, ESR and CRP were not different in the two groups of patients, although the categorical nature of these variables (normal/abnormal) may have hampered the evaluation of possible differences.

The outcome of PMR at 6 months was not different in obese vs. non-obese patients but the former needed a significantly higher cumulative dose of prednisone. The more intuitive interpretation of this finding is that prednisone dose should be adjusted to weight because of the larger volume of distribution in obese patients. Alternatively, the increased inflammation possibly associated with obesity would need more GC.

In conclusion, obesity affects both severity of symptoms and GC utilization. BMI should be considered by clinicians when interpreting symptoms of their PMR patients and deciding their GC doses.

(for the European League Against Rheumatism-American College of Rheumatology PMR classification criteria study group).

Disclosure:

M. A. Cimmino, None; B. Dasgupta, None; C. S. Crowson, None; M. Schirmer, None; C. Dejaco, None; C. Salvarani, None; E. L. Matteson, None.