Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis

Aim To assess whether overweight and obese patients with psoriatic arthritis (PsA) are less likely to achieve sustained minimal disease activity (MDA) state compared to patients with normal weight. Methods A cohort of patients was assessed at the University of Toronto PsA clinic at 6-12-month intervals according to a standard protocol from 2003 to 2012. Patients were categorised into the following groups according to their body mass index (BMI): normal (< 25), overweight (25-30), and obese (> 30). Sustained MDA was defined as achieving low disease activity state in five or more of the following domains for at least 1 year: skin, enthesitis, tender and swollen joint counts, pain, patient global assessment and function. Proportional odds discrete time to event analysis was used to investigate the association between BMI category and the achievement of sustained MDA. Results Of the 557 patients included in the study, 36.2% were classified as overweight and 35.4% were obese. Overall, 66.1% of the patients achieved sustained MDA during the follow-up period. A dose-response association was found between obesity and the probability of achieving sustained MDA in the multivariate regression analysis. Patients in the higher BMI categories were less likely to achieve sustained MDA compared those in the lowest BMI category (overweight: OR 0.66 p= 0.003; obese: OR 0.53 p< 0.0001) after adjusting for potential confounding variables. Conclusions Overweight and obese patients with PsA are less likely to achieve sustained MDA compared to those of normal weight.