{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T06:53:19Z","timestamp":1793083999252,"version":"4.5.0"},"reference-count":27,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2017,5,2]]},"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The aim of this paper was to analyse the impact of obesity, in addition to known predictors, on disease outcome in early rheumatoid arthritis (RA).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Body mass index (BMI) was available in 260 patients from the Swedish pharmacotherapy trial (SWEFOT). Differences in disease activity (DAS28), functional impairment (HAQ), pain (Visual Analogue Scale, VAS-pain) and radiographic damage were evaluated over 24 months between BMI categories (obese BMI &gt;30, n=43; overweight BMI=25\u201329.9, n=74; normal BMI &lt;25, n=143) using non-parametric testing. Predictors of European League Against Rheumatism non-remission (DAS28 \u22652.6) at 24 months of follow-up were evaluated using binary univariate and multivariate logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Obesity at baseline was associated with worse continuous-scale clinical outcomes over 24 months (DAS28, HAQ and VAS-pain at last visit: obese vs normal: p&lt;0.001; obese vs overweight: p&lt;0.05). Furthermore, obese patients compared with non-obese patients had significantly greater odds of non-remission at 24 months (adjusted OR (aOR) 5.2; 95% CI 1.8 to 15.2). Other independent predictors were female sex (aOR 2.6; 95% CI 1.1 to 5.8), current smoking (aOR 2.6; 95% CI 1.1 to 6.3) and HAQ (per-unit increase, aOR 1.9; 95% CI 1.1 to 3.4). The pattern was similar among seropositive and seronegative patients; and in the subgroups of methotrexate responders and patients randomised at 3 months to add-on of sulfasalazine+hydroxychloroquine, although not significant with add-on of infliximab. Obesity had no independent association to radiographic progression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In this early RA trial reflecting today\u2019s standard treatment, obesity, in addition to sex, smoking and functional impairment strongly lowered the chance of attaining good clinical outcomes, including remission, today\u2019s treatment goal. This highlights the importance of considering lifestyle modification as one of the cornerstones of RA care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>NCT00764725; Post-results. WHO database at the Karolinska University Hospital: CT20080004.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2017-000458","type":"journal-article","created":{"date-parts":[[2017,8,10]],"date-time":"2017-08-10T20:10:13Z","timestamp":1502395813000},"page":"e000458","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":73,"title":["Obesity is a strong predictor of worse clinical outcomes and treatment responses in early rheumatoid arthritis: results from the SWEFOT trial"],"prefix":"10.1136","volume":"3","clinical-trial-number":[{"clinical-trial-number":"nct00764725","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Adrian","family":"Levitsky","sequence":"first","affiliation":[{"name":"Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden"},{"name":"Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Brismar","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingi\u00e4ld","family":"Hafstr\u00f6m","sequence":"additional","affiliation":[{"name":"Unit of Gastroenterology and Rheumatology, Department of Medicine, Huddinge, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Hambardzumyan","sequence":"additional","affiliation":[{"name":"Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden"},{"name":"Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Lourdudoss","sequence":"additional","affiliation":[{"name":"Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald F","family":"van Vollenhoven","sequence":"additional","affiliation":[{"name":"Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden"},{"name":"Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saedis","family":"Saevarsdottir","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,8,9]]},"reference":[{"key":"2025090313360906000_3.2.e000458.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.144139"},{"key":"2025090313360906000_3.2.e000458.2","first-page":"1010","article-title":"How large are the productivity losses in contemporary patients with RA","volume":"70","author":"Neovius","year":"2011","journal-title":"and how soon in relation to diagnosis do they develop? 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Increasing Circulating Adiponectin after DMARD Initiation Is Associated with Radiographic Progression in Early Aggressive RA, Regardless of Treatment Strategy. 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