{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T19:13:44Z","timestamp":1791054824551,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2015,6,26]],"date-time":"2015-06-26T00:00:00Z","timestamp":1435276800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"VA Clinical Science Research and Development Career Development Award","award":["IK2 CX000955"],"award-info":[{"award-number":["IK2 CX000955"]}]},{"name":"Rheumatology Research Foundation Investigator Award"},{"name":"NIH","award":["1-K24-AR-055259-01"],"award-info":[{"award-number":["1-K24-AR-055259-01"]}]},{"name":"VA Health Service Research and Development Career Development Award","award":["07-221"],"award-info":[{"award-number":["07-221"]}]},{"name":"VA Merit Award"},{"name":"The VA Rheumatoid Arthritis Registry"},{"name":"Nebraska Arthritis Outcomes Research Center at the University of Nebraska Medical Center"},{"name":"VA Health Services Research and Development Program of the Veterans Health Administration"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>In contrast to what is observed in the general population, a low body mass index (BMI) has been associated with accelerated mortality in patients with rheumatoid arthritis (RA). The aim of this study was to assess whether weight loss might explain these seemingly paradoxical observations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Our study included patients identified from the Veterans Affairs (VA) RA Registry. Dates of death were abstracted from VA electronic medical records. The BMI at each study visit and the change from the previous visit were determined. The maximum BMI of each patient was also obtained from medical records. The annualized rate of BMI loss was determined from the slope of change (per year) in BMI over visits within the preceding 13 months. Cox multivariable proportional hazards models were used to assess associations between BMI measures and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In a sample of 1,674 patients, 312 deaths occurred over 9,183 person\u2010years. A loss in BMI of \u22651 kg\/m<jats:sup>2<\/jats:sup> was associated with a greater risk of death, after adjustment for demographics, comorbidities, BMI, smoking, and RA therapies (hazard ratio [HR] 1.99, 95% confidence interval [95% CI] 1.53\u20132.59, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). This association remained significant in a subsample analysis adjusting for C\u2010reactive protein and physical function (HR 1.81, 95% CI 1.36\u20132.41, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Weight loss at an annualized rate of \u22653 kg\/m<jats:sup>2<\/jats:sup> was associated with the greatest risk of death (HR 2.49, 95% CI 1.73\u20133.57, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Low BMI (&lt;20 kg\/m<jats:sup>2<\/jats:sup>) in patients with a history of obesity (&gt;30 kg\/m<jats:sup>2<\/jats:sup>) was associated with the greatest risk (HR 8.52, 95% CI 4.10\u201317.71, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Weight loss is a strong predictor of death in patients with RA. These observations may explain the observed obesity paradox and do not support a biologically protective role of obesity.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.39136","type":"journal-article","created":{"date-parts":[[2015,5,4]],"date-time":"2015-05-04T06:48:50Z","timestamp":1430722130000},"page":"1711-1717","source":"Crossref","is-referenced-by-count":104,"title":["Weight Loss, the Obesity Paradox, and the Risk of Death in Rheumatoid Arthritis"],"prefix":"10.1002","volume":"67","author":[{"given":"Joshua F.","family":"Baker","sequence":"first","affiliation":[{"name":"Philadelphia VA Medical Center and University of Pennsylvania Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Billig","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleb","family":"Michaud","sequence":"additional","affiliation":[{"name":"Nebraska\u2212Western Iowa VA Medical Center, Omaha, Nebraska, University of Nebraska Medical Center, Omaha and National Data Bank for Rheumatic Diseases Wichita Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Philadelphia VA Medical Center and University of Pennsylvania Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liron","family":"Caplan","sequence":"additional","affiliation":[{"name":"Denver VA Medical Center Denver Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant W.","family":"Cannon","sequence":"additional","affiliation":[{"name":"Salt Lake City VA Medical Center, Salt Lake City, Utah and University of Utah Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Stokes","sequence":"additional","affiliation":[{"name":"Boston University School of Public Health Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas","family":"Majithia","sequence":"additional","affiliation":[{"name":"G. V. (Sonny) Montgomery VA Medical Center, Montgomery, Mississippi and University of Mississippi Medical Center Jackson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted R.","family":"Mikuls","sequence":"additional","affiliation":[{"name":"Nebraska\u2013Western Iowa VA Medical Center, Omaha, Nebraska and University of Nebraska Medical Center Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,6,26]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21627"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keq232"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2013.10.004"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.02.00532002"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0802060"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)71123-4"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.113905"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.14.1624"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478-7954-12-6"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2010.41"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000075"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1304501"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwf019"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa055643"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.121012"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21777"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar3471"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20629"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar3190"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2010.03.003"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21778"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780310302"},{"key":"e_1_2_6_24_1","unstructured":"United States Department of Veterans Affairs.VA Informatics and Computing Infrastructure. 2014 [cited 2014]. URL:http:\/\/www.hsrd.research.va.gov\/for_researchers\/vinci\/cdw.cfm."},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181b5f520"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(199910)42:10<2220::AID-ANR26>3.0.CO;2-5"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000160417.39497.a9"},{"key":"e_1_2_6_29_1","first-page":"37","article-title":"Accuracy of computerized outpatient diagnoses in a Veterans Affairs general medicine clinic","volume":"8","author":"Szeto HC","year":"2002","journal-title":"Am J Manag Care"},{"key":"e_1_2_6_30_1","first-page":"S597","article-title":"The development of a rheumatic disease research comorbidity index for use in outpatients with RA, OA, SLE, and fibromyalgia (FMS)","volume":"56","author":"Michaud K","year":"2007","journal-title":"Arthritis Rheum"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.090781"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2011.09.039"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2010.04.003"},{"key":"e_1_2_6_34_1","first-page":"718","article-title":"Unintentional weight loss in older adults","volume":"89","author":"Gaddey HL","year":"2014","journal-title":"Am Fam Physician"}],"container-title":["Arthritis &amp; Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fart.39136","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fart.39136","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/art.39136","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T11:29:36Z","timestamp":1759922976000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/art.39136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,6,26]]},"references-count":33,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2015,7]]}},"alternative-id":["10.1002\/art.39136"],"URL":"https:\/\/doi.org\/10.1002\/art.39136","archive":["Portico"],"relation":{},"ISSN":["2326-5191","2326-5205"],"issn-type":[{"value":"2326-5191","type":"print"},{"value":"2326-5205","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,6,26]]}}}