The Effect of Obesity in Individuals with Ankylosing Spondylitis: A Single Center Cohort Study

Yıl 2024, , 43 - 50, 29.04.2024

Elif Gur Kabul , Bilge Başakçı Çalık , Sinem Kuru , Murat Yiğit , Veli Çobankara

https://doi.org/10.25048/tudod.1450923

Öz

Aim: The aim of this study was to compare the disease activity and functional status of individuals with Ankylosing Spondylitis (AS)
according to body mass index (BMI).
Material and Methods: This study, which was planned as a single-center cohort study, included 437 individuals with AS. Disease
activities were evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and functional levels with the Bath
Ankylosing Spondylitis Functional Index (BASFI). Participants were categorized in 3 groups according to BMI data based on the criteria
of the World Health Organization: normal weight:20-24.9; overweight: 25-29.9; obese:≥30. One Way Anova Test, Kruskal Wallis Test,
Mann Whitney U test and Chi-Square Test were used to compare independent group differences. Linear regression models were used
to describe the relationship between BASDAI, BASFI (dependent variables) and BMI categories (independent variables). Univariate
regression analyses were performed (only one independent variable in the model).
Results: Among 437 patients with AS, 30.2% are normal weight, 39.5% are overweight and 30.2% are obese. Analysis results of data
between BMI groups; significant difference was in BASFI (p=0.001) in favor of the obese group. In binary group comparisons for BASFI;
there was a significant difference in favor of the obese group between normal and obese (p=0.002) and between overweight and obese
(p=0.001). Obese was significantly associated with higher BASFI score compared to the normal weight group without adjustment for
covariates (β:-0.37, 95%CI -0.66/-0.08, p=0.006). On the other hand, there was no association between BASDAI and obesity (β:-0.50,
95%CI -1.11/ 1.22, p:0.130).
Conclusion: The BMI of Turkish AS individuals in a single center cohort had no effect on disease activity, but obesity had a worse effect
on functional level.

Anahtar Kelimeler

Ankylosing spondylitis, Body mass index, Overweight, Disease

Proje Numarası

None

Ankilozan Spondilitli Bireylerde Obezitenin Etkisi: Tek Merkezli Kohort Çalışması

Öz

Amaç: Bu çalışmanın amacı Ankilozan Spondilitli (AS) bireylerin hastalık aktivitesini ve fonksiyonel durumlarını vücut kütle indeksine
(VKİ) göre karşılaştırmaktır.
Gereç ve Yöntemler: Tek merkezli kohort çalışması olarak planlanan bu çalışmaya, AS tanılı 437 birey dahil edildi. Hastalık aktiviteleri
Bath Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAI), fonksiyonel düzeyleri ise Bath Ankilozan Spondilit Fonksiyonel İndeksi
(BASFI) ile değerlendirildi. Katılımcılar, Dünya Sağlık Örgütü'nün kriterlerine dayanarak VKİ verilerine göre 3 gruba ayrıldı: normal
ağırlık:20-24,9; fazla kilolu: 25-29,9; obez:≥30. Bağımsız grup farklılıklarının karşılaştırılmasında One Way Anova Testi, Kruskal Wallis Testi, Mann Whitney U testi ve Ki-Kare Testi kullanıldı. BASDAI, BASFI (bağımlı değişkenler) ve VKİ kategorileri (bağımsız
değişkenler) arasındaki ilişkiyi tanımlamak için doğrusal regresyon modelleri kullanıldı. Tek değişkenli regresyon analizleri yapıldı
(modelde yalnızca bir bağımsız değişken).
Bulgular: AS'li 437 hastanın % 30.2’i normal ağırlıkta, %39,5'i fazla kilolu, %30,2'i ise obezdir.
UKİ grupları arasındaki verilerin analiz sonuçlarında; BASFI'de (p=0,001) obez grup lehine anlamlı fark vardı. BASFI için ikili grup
karşılaştırmalarında; normal ile obez (p=0,002) ve fazla kilolu ile obez (p=0,001) arasında obez grup lehine anlamlı fark vardı. Ortak
değişkenler için düzeltme yapılmadan normal ağırlıklı grupla karşılaştırıldıklarında, obezite daha yüksek BASFI skoru ile anlamlı
düzeyde ilişkiliydi (β:-0,37, %95CI -0,66/-0,08, p=0,006). Öte yandan, BASDAI ile obezite arasında herhangi bir ilişki yoktu (β:-0,50,
95%CI -1,11/ 1,22, p:0,130).
Sonuç: Tek merkezli bir kohorttaki, Türk AS’li bireylerin VKİ’nin hastalık aktivitesi üzerine etkisi yoktu, ancak obezite fonksiyonel
düzey üzerinde daha kötü bir etkiye sahip idi.

Anahtar Kelimeler

Ankilozan spondilit, Vücut kütle indeksi, Fazla kilo, Hastalık

Etik Beyan

According to the Helsinki Declaration of 1975, as revised in 1983, it was determined at the meeting held by the local ethical committee that there was no ethical problem for the study to be carried out (decision no: 21, dated: 11.30.2021). All patients were informed verbally and informed consent forms were signed.

Destekleyen Kurum

This study did not receive any specific grant from funding agencies.

Proje Numarası

None

Teşekkür

None

Kaynakça

• 1. Haroon NN, Paterson JM, Li P, Inman RD, Haroon N. Patients with ankylosing spondylitis have increased cardiovascular and cerebrovascular mortality: a population-based study. Ann Intern Med. 2015;163:409-416.
• 2. Bengtsson K, Forsblad-d'Elia H, Lie E, Klingberg E, Dehlin M, Exarchou S, Lindström U, Askling J, Jacobsson LTH. Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Res Ther. 2017;19(1):102.
• 3. Mathieu S, Soubrier M. Cardiovascular events in ankylosing spondylitis: a 2018 meta-analysis. Ann Rheum Dis. 2019;78: e57.
• 4. Obesity and Overweight. World Health Organization. http:// www. who.int/mediacentre/factsheets/fs311/en/ Accessed 17.11.2021.).
• 5. World Health Organization: Obesity and overweight: fact sheet N0 311; 2012. http://www.who.int/mediacentre/factsheets/ fs311/en/index.html.
• 6. Jackson AS, Stanforth PR, Gagnon J, Rankinen T, Leon AS, Rao DC, Skinner JS, Bouchard C, Wilmore JH. The effect of sex, age and race on estimating percentage body fat from body mass index: The Heritage Family Study. Int J Obes Relat Metab Disord. 2002;26(6):789-796.
• 7. Liew JW, Huang IJ, Louden DN, Singh N, Gensler LS. Association of body mass index on disease activity in axial spondyloarthritis: systematic review and meta-analysis. RMD Open. 2020; 6: e001225.
• 8. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index. J Rheumatol. 1994;21(12):2286-2291.
• 9. Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, Jenkinson T. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994;21(12):2281-2285.
• 10. Boonen A, van der Linden SM. The burden of ankylosing spondylitis. J Rheumatol Suppl. 2006;78:4-11.
• 11. Zochling J, Braun J. Mortality in rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol. 2009;27(4):S127- 130.
• 12. Why use BMI? Harvard School of Public Health. https://www. hsph.harvard.edu/obesity-prevention-source/obesity-definition/ obesity-definition-full-story/ Accessed on 15 Sept 2016
• 13. Lee YX, Kwan YH, Png WY, Lim KK, Tan CS, Lui NL, Chew EH, Thumboo J, Østbye T, Fong W. Association of obesity with patient-reported outcomes in patients with axial spondyloarthritis: a cross-sectional study in an urban Asian population. Clin Rheumatol. 2017;36(10):2365-2370.
• 14. Durcan L, Wilson F, Conway R, Cunnane G, O’shea FD. Increased Body Mass Index in Ankylosing Spondylitis Is Associated with Greater Burden of Symptoms and Poor Perceptions of the Benefits of Exercise. J Rheumatol. 2012;39:2310-2314.
• 15. Berg IJ, Semb AG, van der Heijde D, Kvien TK, Dagfinrud H, Hisdal J, Provan SA. FRI0214 Disease activity and risk of cardiovascular disease in patients with ankylosing spondylitis with high and low body mass index. Ann Rheum Dis. 2015; 74: 501-502.
• 16. Maas F, Arends S, van der Veer E, Wink F, Efde M, Bootsma H, Brouwer E, Spoorenberg A. Obesity is common in axial spondyloarthritis and associated with poor clinical outcome. J Rheumatol. 2016;43:383-387.
• 17. Fitzgerald G, Gallagher P, Sullivan C, O Rourke K, Sheehy C, Stafford F, Silke C, Haroon M, Mullan R, Fraser S, Murphy G, Chavrimootoo S, FitzGerald O, O' Shea F. Obese axial spondyloarthropathy patients have worse disease outcomes [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10).
• 18. Bindesbøll C, Garrido-Cumbrera M, Bakland G, Dagfinrud HS, EMAS working group. Sat0319 obesity and associated factors in Norwegian axial spondyloarthritis patients. results from the European map of axial spondyloarthritis survey. Ann Rheum Dis. 2019;1238:1-1238.
• 19. Rubio Vargas R, van den Berg R, van Lunteren M, Ez-Zaitouni Z, Bakker PA, Dagfinrud H, Ramonda R, Landewé R, Molenaar E, van Gaalen FA, van der Heijde D. Does body mass index (BMI) influence the Ankylosing Spondylitis Disease Activity Score in axial spondyloarthritis?: Data from the SPACE cohort. RMD Open. 2016;2(1):e000283.
• 20. Toy S, Ozbag D, Altay Z. The effects of pre-obesity on quality of life, disease activity, and functional status in patients with ankylosing spondylitis. North Clin Istanb. 2017;4 (1):52-59.
• 21. van der Slik B, Spoorenberg A, Wink F, Bos R, Bootsma H, Maas F, Arends S. Although female patients with ankylosing spondylitis score worse on disease activity than male patients and improvement in disease activity is comparable, male patients show more radiographic progression during treatment with TNF-α inhibitors. Semin Arthritis Rheum. 2019;48(5):828-833.
• 22. Falkenbach A, Franke A, Van Tubergen A, Van Der Linden S. Assessment of functional ability in younger and older patients with ankylosing spondylitis: performance of the bath ankylosing spondylitis functional index. Am J Phys Med Rehabil. 2002;81(6):416-420.
• 23. Fabre S, Molto A, Dadoun S, Rein C, Hudry C, Kreis S, Fautrel B, Pertuiset E, Gossec L. Physical activity in patients with axial spondyloarthritis: a cross-sectional study of 203 patients. Rheumatol Int. 2016;36(12):1711-1718.
• 24. Kane A How fat affects arthritis. Arthritis Foundation. http:// www.arthritis.org/living-with-arthritis/comorbidities/obesity- arthritis/fatand-arthritis.php. Accessed on 14 Sept 2016
• 25. McVinnie DS. Obesity and pain. Br J Pain. 2013;7(4):163-170.
• 26. Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res. 2015;8:399-408.
• 27. Zochling J, van der Heijde D, Dougados M, Braun J. Current evidence for the management of ankylosing spondylitis: A systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Ann Rheum Dis. 2006;65:423-432.
• 28. Dagfinrud H, Kvien TK, Hagen KB. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev. 2008;1:CD002822.