Impact de l'obésité sur l'expression et le devenir de la polyarthrite rhumatoïde

Obesity is a condition of excess fat mass associated with increased morbidity and mortality, mainly due to cardiovascular disease. Rheumatoid arthritis is also a condition at increased cardiovascular risk, characterized by a modification of body composition with loss of muscle mass and increased adiposity. Obese people have a slightly increased risk of developing RA. Obese RA patients have higher disease activity, worse function and quality of life, and need higher doses of disease-modifying drugs (DMARDs). Nevertheless, obese RA patients have less ultrasonography and MRI-detected synovitis vs. normal weight patients and less radiographic progression over time. Quite surprisingly, obese RA patients also have lower cardiovascular mortality vs. low-weight patients. Thus, disease activity and severity may be overestimated in obese patients and possibly lead to overtreatment. Strategies to reduce weight may be promoted, as there is some evidence that weight loss ameliorates pain and function and results in less DMARDs use.