{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T17:51:42Z","timestamp":1784224302395,"version":"3.55.0"},"reference-count":132,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>This translational synthesis highlights the potential role of obesity-induced low-grade chronic inflammation in modulating clinical outcomes among patients with spondyloarthritis (SpA). Obesity transforms adipose tissue into a pro-inflammatory endocrine organ, where hypertrophic adipocytes release adipokines such as leptin alongside cytokines including TNF-\u03b1 and IL-6, potentially contributing to macrophage polarization toward an M1 phenotype and activating NF-\u03baB signaling pathways. This systemic immunometabolic priming may lower activation thresholds at the enthesis\u2014the primary pathological site in SpA\u2014potentially amplifying IL-23\/IL-17 axis activity via Th17 bias, innate-like lymphocyte responses, and stromal\u2013immune crosstalk under mechanical stress. Clinically, patients with SpA and obesity have been reported to demonstrate heightened disease activity (BASDAI, ASDAS), impaired function (BASFI), accelerated radiographic progression (syndesmophytes, enthesophytes), and diminished biologic response rates, potentially attributable to pharmacokinetic alterations (e.g., subtherapeutic TNF inhibitor levels) and pharmacodynamic resistance. Multisystem comorbidities, including non-alcoholic fatty liver disease, cardiovascular events, metabolic syndrome, sleep disturbances, and depression, further exacerbate morbidity and diminish quality of life. Therapeutic implications emphasize obesity as a modifiable disease modifier. Weight loss interventions, including hypocaloric diets, anti-inflammatory regimens (e.g., Mediterranean diet), multicomponent exercise, GLP-1 receptor agonists, and bariatric surgery, have been associated with reductions in inflammatory biomarkers, improved remission rates (MDA, DAPSA), and prolonged drug survival by restoring adipokine balance and disrupting mechano-inflammatory loops. Future randomized controlled trials should prioritize long-term evaluations of integrated multidisciplinary strategies that combine metabolic optimization with immunomodulatory therapies, addressing adherence challenges through psychological support and patient-tailored protocols, while elucidating dose\u2013response relationships for GLP-1RAs and exercise in diverse SpA subtypes to establish precision management paradigms that mitigate cardiometabolic burden and improve holistic outcomes.<\/jats:p>","DOI":"10.3390\/metabo16050347","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:02:27Z","timestamp":1779375747000},"page":"347","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Obesity, Low-Grade Chronic Inflammation, and Clinical Outcomes in Spondyloarthritis: A Translational Synthesis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7848-6600","authenticated-orcid":false,"given":"Andrej","family":"Belan\u010di\u0107","sequence":"first","affiliation":[{"name":"Department of Basic and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Rijeka, Bra\u0107e Branchetta 20, 51000 Rijeka, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0350-6800","authenticated-orcid":false,"given":"Mislav","family":"Radi\u0107","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital of Split, 21000 Split, Croatia"},{"name":"Internal Medicine Department, School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0632-8843","authenticated-orcid":false,"given":"Marija","family":"Rogoznica Pavlovi\u0107","sequence":"additional","affiliation":[{"name":"Hospital for Medical Rehabilitation of Heart and Lung Diseases and Rheumatism \u2018Thalassotherapia-Opatija\u2019, 51410 Opatija, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijana","family":"Vu\u010dkovi\u0107","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Dialysis, Department of Internal Medicine, University Hospital of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8529-2345","authenticated-orcid":false,"given":"Petra \u0160imac","family":"Pri\u017emi\u0107","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1255-8653","authenticated-orcid":false,"given":"Elvira Meni Maria","family":"Gkrinia","sequence":"additional","affiliation":[{"name":"Independent Researcher, 11741 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2645-7597","authenticated-orcid":false,"given":"Josipa","family":"Radi\u0107","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, School of Medicine, University of Split, 21000 Split, Croatia"},{"name":"Division of Nephrology and Dialysis, Department of Internal Medicine, University Hospital of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3722-9701","authenticated-orcid":false,"given":"Almir","family":"Fajki\u0107","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, Faculty of Medicine, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"One year in review 2017: Spondyloarthritis","volume":"36","author":"Terenzi","year":"2018","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"107","DOI":"10.5312\/wjo.v2.i12.107","article-title":"Classification criteria for spondyloarthropathies","volume":"2","author":"Akgul","year":"2011","journal-title":"World J. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2127","DOI":"10.1016\/S0140-6736(11)60071-8","article-title":"Spondyloarthritis","volume":"377","author":"Dougados","year":"2011","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1136\/annrheumdis-2012-201299","article-title":"Obesity and the risk of psoriatic arthritis: A population-based study","volume":"71","author":"Love","year":"2012","journal-title":"Ann. Rheum. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.autrev.2014.07.001","article-title":"Obesity in autoimmune diseases: Not a passive bystander","volume":"13","author":"Versini","year":"2014","journal-title":"Autoimmun. Rev."},{"key":"ref_6","first-page":"7353420","article-title":"Biomarkers of Inflammation in Obesity-Psoriatic Patients","volume":"2019","author":"Fabbrocini","year":"2019","journal-title":"Mediat. Inflamm."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1080\/08830185.2018.1539084","article-title":"Psoriasis and cardiovascular disease: The elusive link","volume":"38","author":"Manolis","year":"2019","journal-title":"Int. Rev. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1111\/j.1600-0625.2011.01261.x","article-title":"The \u2018psoriatic march\u2019: A concept of how severe psoriasis may drive cardiovascular comorbidity","volume":"20","author":"Boehncke","year":"2011","journal-title":"Exp. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Blake, T., Gullick, N.J., Hutchinson, C.E., and Barber, T.M. (2020). Psoriatic disease and body composition: A systematic review and narrative synthesis. PLoS ONE, 15.","DOI":"10.1101\/2020.05.18.20104802"},{"key":"ref_10","unstructured":"World Health Organization (2015, October 28). Obesity and Overweight. Available online: www.who.int\/mediacentre\/factsheets\/fs311\/en\/."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1016\/S0140-6736(05)67483-1","article-title":"Obesity","volume":"366","author":"Haslam","year":"2005","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3899\/jrheum.150648","article-title":"Obesity Is Common in Axial Spondyloarthritis and Is Associated with Poor Clinical Outcome","volume":"43","author":"Maas","year":"2016","journal-title":"J. Rheumatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s00296-020-04775-2","article-title":"Comorbidities in psoriatic arthritis: A systematic review and meta-analysis","volume":"41","author":"Gupta","year":"2021","journal-title":"Rheumatol. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1136\/annrheumdis-2013-204448","article-title":"Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis","volume":"74","author":"Eder","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_15","first-page":"144","article-title":"The role of obesity on inflammation and damage in spondyloarthritis: A systematic literature review on body mass index and imaging","volume":"38","author":"Bakirci","year":"2020","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1136\/annrheumdis-2013-203643","article-title":"Proof of concept: Enthesitis and new bone formation in spondyloarthritis are driven by mechanical strain and stromal cells","volume":"73","author":"Jacques","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"C375","DOI":"10.1152\/ajpcell.00379.2020","article-title":"Adipose tissue inflammation and metabolic dysfunction in obesity","volume":"320","author":"Kawai","year":"2021","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Gkrinia, E.M.M., and Belan\u010di\u0107, A. (2025). The Mechanisms of Chronic Inflammation in Obesity and Potential Therapeutic Strategies: A Narrative Review. Curr. Issues Mol. Biol., 47.","DOI":"10.3390\/cimb47050357"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2446","DOI":"10.1002\/eji.201545502","article-title":"The \u201cBig Bang\u201d in obese fat: Events initiating obesity-induced adipose tissue inflammation","volume":"45","author":"Wensveen","year":"2015","journal-title":"Eur. J. Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Santillana, N., Astudillo-Guerrero, C., D\u2019Espessailles, A., and Cruz, G. (2023). White Adipose Tissue Dysfunction: Pathophysiology and Emergent Measurements. Nutrients, 15.","DOI":"10.3390\/nu15071722"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s12986-023-00731-6","article-title":"Weight cycling based on altered immune microenvironment as a result of metaflammation","volume":"20","author":"Li","year":"2023","journal-title":"Nutr. Metab."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zatterale, F., Longo, M., Naderi, J., Raciti, G.A., Desiderio, A., Miele, C., and Beguinot, F. (2020). Chronic Adipose Tissue Inflammation Linking Obesity to Insulin Resistance and Type 2 Diabetes. Front. Physiol., 10.","DOI":"10.3389\/fphys.2019.01607"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1161\/01.RES.0000163635.62927.34","article-title":"Adipose tissue, inflammation, and cardiovascular disease","volume":"96","author":"Berg","year":"2005","journal-title":"Circ. Res."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Tanti, J.F., Ceppo, F., Jager, J., and Berthou, F. (2013). Implication of inflammatory signaling pathways in obesity-induced insulin resistance. Front. Endocrinol., 3.","DOI":"10.3389\/fendo.2012.00181"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"189","DOI":"10.2174\/18715303113139990041","article-title":"The dual role of free fatty acid signaling in inflammation and therapeutics","volume":"7","author":"Volpe","year":"2013","journal-title":"Recent Pat. Endocr. Metab. Immune Drug Discov."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1186\/2047-783X-15-S2-120","article-title":"Proinflammatory cytokines Il-6 and TNF-\u03b1 and the development of inflammation in obese subjects","volume":"15","author":"Popko","year":"2010","journal-title":"Eur. J. Med. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"851","DOI":"10.5114\/aoms.2016.58928","article-title":"Obesity and inflammation: The linking mechanism and the complications","volume":"13","author":"Ellulu","year":"2017","journal-title":"Arch. Med. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1001\/jama.2024.20917","article-title":"Axial Spondyloarthritis: A Review","volume":"333","author":"Bittar","year":"2025","journal-title":"JAMA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s00281-021-00836-1","article-title":"Cytokine \u201cfine tuning\u201d of enthesis tissue homeostasis as a pointer to spondyloarthritis pathogenesis with a focus on relevant TNF and IL-17 targeted therapies","volume":"43","author":"Russell","year":"2021","journal-title":"Semin. Immunopathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/j.berh.2014.10.009","article-title":"The role of mechanical stress in the pathogenesis of spondyloarthritis and how to combat it","volume":"28","author":"Jacques","year":"2014","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/imr.12840","article-title":"Interleukin-23 pathway at the enthesis: The emerging story of enthesitis in spondyloarthropathy","volume":"294","author":"Bridgewood","year":"2020","journal-title":"Immunol. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1177\/1759720X18783894","article-title":"Inflammation, obesity and rheumatic disease: Common mechanistic links. A narrative review","volume":"10","author":"Nikiphorou","year":"2018","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Haberman, R.H., Ogdie, A., Merola, J.F., Scher, J.U., and Eder, L. (2025). The obesity-inflammation axis in psoriatic disease: Mechanisms and therapeutic strategies. Nat. Rev. Rheumatol., Epub ahead of print.","DOI":"10.1038\/s41584-025-01326-6"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1002\/art.43095","article-title":"Metabolic Stress Expands Polyfunctional, Proinflammatory Th17 Cells in Patients with Psoriatic Arthritis for Whom There Is Interleukin-23-Independent Interleukin-17 Production","volume":"77","author":"Stober","year":"2025","journal-title":"Arthritis Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"168069","DOI":"10.1016\/j.bbadis.2025.168069","article-title":"Leptin\/PPAR\u03b3 interaction mediates obesity-driven Th17 differentiation in rheumatoid arthritis","volume":"1872","author":"Ren","year":"2026","journal-title":"Biochim. Biophys. Acta Mol. Basis Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e20240677","DOI":"10.1084\/jem.20240677","article-title":"Adipose tissue harbors pathogenic T cells in obesity that exacerbate inflammatory arthritis","volume":"222","author":"Faust","year":"2025","journal-title":"J. Exp. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"8639","DOI":"10.7150\/thno.116796","article-title":"Systemic inflammation-induced adipose tissue remodeling drives psoriasis exacerbation in obesity through epigenetic and immunometabolic dysregulation","volume":"15","author":"Jang","year":"2025","journal-title":"Theranostics"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"101966","DOI":"10.1016\/j.berh.2024.101966","article-title":"Enthesopathies\u2014Mechanical, inflammatory or both?","volume":"38","author":"Baraliakos","year":"2024","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e293","DOI":"10.1016\/S2665-9913(23)00074-7","article-title":"Pathways driving tendinopathy and enthesitis: Siblings or distant cousins in musculoskeletal medicine?","volume":"5","author":"Crowe","year":"2023","journal-title":"Lancet Rheumatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s11926-015-0507-2","article-title":"IL-23 responsive innate-like T cells in spondyloarthritis: The less frequent they are, the more vital they appear","volume":"17","author":"Venken","year":"2015","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Porta, S., Otero-Losada, M., K\u00f6lliker Frers, R.A., Cosentino, V., Kerzberg, E., and Capani, F. (2021). Adipokines, Cardiovascular Risk, and Therapeutic Management in Obesity and Psoriatic Arthritis. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.590749"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Anselmo, S., Bonaccorso, E., Gangemi, C., Sancataldo, G., Conti Nibali, V., and D\u2019Angelo, G. (2025). Lipid Rafts in Signalling, Diseases, and Infections: What Can Be Learned from Fluorescence Techniques?. Membranes, 15.","DOI":"10.3390\/membranes15010006"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1038\/s41580-023-00607-w","article-title":"Tuning BCR signalling at lipid rafts","volume":"24","author":"Strzyz","year":"2023","journal-title":"Nat. Rev. Mol. Cell Biol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"102760","DOI":"10.1016\/j.autrev.2021.102760","article-title":"Exploring IL-17 in spondyloarthritis for development of novel treatments and biomarkers","volume":"20","author":"Groen","year":"2021","journal-title":"Autoimmun. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Hasan, A., Akhter, N., Al-Roub, A., Thomas, R., Kochumon, S., Wilson, A., Koshy, M., Al-Ozairi, E., Al-Mulla, F., and Ahmad, R. (2019). TNF-\u03b1 in Combination with Palmitate Enhances IL-8 Production via The MyD88- Independent TLR4 Signaling Pathway: Potential Relevance to Metabolic Inflammation. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20174112"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Toussirot, E. (2020). Mini-Review: The Contribution of Adipokines to Joint Inflammation in Inflammatory Rheumatic Diseases. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.606560"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1002\/art.38968","article-title":"Serum adipokine levels in patients with ankylosing spondylitis and their relationship to clinical parameters and radiographic spinal progression","volume":"67","author":"Syrbe","year":"2015","journal-title":"Arthritis Rheumatol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Diaconu, A.D., \u0218orodoc, L., Pom\u00eerleanu, C., Foia, L.G., \u0218orodoc, V., Lionte, C., Russu, M., L\u0103pu\u0219te, V., Ghemi\u0219, L., and Ancu\u021ba, C. (2025). Biomarkers of Inflammation and Radiographic Progression in Axial Spondyloarthritis: A Clinical Evaluation of Leptin, Adiponectin, TNF-\u03b1, and IL-17A. J. Clin. Med., 14.","DOI":"10.3390\/jcm14155605"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"103352","DOI":"10.1016\/j.drudis.2022.103352","article-title":"Adipokines as targets in musculoskeletal immune and inflammatory diseases","volume":"27","author":"Pino","year":"2022","journal-title":"Drug Discov. Today"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.bcp.2019.03.030","article-title":"Adipokines: Linking metabolic syndrome, the immune system, and arthritic diseases","volume":"165","author":"Francisco","year":"2019","journal-title":"Biochem. Pharmacol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"348","DOI":"10.4103\/ijem.ijem_176_22","article-title":"Obesity, Lipid Profile and Cytokines in Spondyloarthritis","volume":"26","author":"Slouma","year":"2022","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2563","DOI":"10.1056\/NEJMra1406182","article-title":"Ankylosing Spondylitis and Axial Spondyloarthritis","volume":"374","author":"Taurog","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1056\/NEJMra1909094","article-title":"Reframing Immune-Mediated Inflammatory Diseases through Signature Cytokine Hubs","volume":"385","author":"Schett","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s00281-021-00837-0","article-title":"Novel immune cell phenotypes in spondyloarthritis pathogenesis","volume":"43","author":"Mauro","year":"2021","journal-title":"Semin. Immunopathol."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Angajala, A., Lim, S., Phillips, J.B., Kim, J.H., Yates, C., You, Z., and Tan, M. (2018). Diverse Roles of Mitochondria in Immune Responses: Novel Insights into Immuno-Metabolism. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.01605"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/imcb.12311","article-title":"Epigenetics in rheumatoid arthritis; fibroblast-like synoviocytes as an emerging paradigm in the pathogenesis of the disease","volume":"98","author":"Karami","year":"2020","journal-title":"Immunol. Cell Biol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.pmrj.2016.09.011","article-title":"Obesity, Vascular Disease, and Lumbar Disk Degeneration: Associations of Comorbidities in Low Back Pain","volume":"9","author":"Kendall","year":"2017","journal-title":"PM&R"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"R115","DOI":"10.1186\/ar3841","article-title":"Body mass index influences the response to infliximab in ankylosing spondylitis","volume":"14","author":"Ottaviani","year":"2012","journal-title":"Arthritis Res. Ther."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1002\/acr.24416","article-title":"Do Obesity and Overweight Influence Disease Activity Measures in Axial Spondyloarthritis? A Systematic Review and Meta-Analysis","volume":"73","author":"Ortolan","year":"2021","journal-title":"Arthritis Care Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2310","DOI":"10.3899\/jrheum.120595","article-title":"Increased body mass index in ankylosing spondylitis is associated with greater burden of symptoms and poor perceptions of the benefits of exercise","volume":"39","author":"Durcan","year":"2012","journal-title":"J. Rheumatol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1093\/rheumatology\/kes242","article-title":"Obesity and psoriatic arthritis: From pathogenesis to clinical outcome and management","volume":"52","author":"Russolillo","year":"2013","journal-title":"Rheumatology"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"i71","DOI":"10.1136\/ard.2010.144097","article-title":"The early phase of psoriatic arthritis","volume":"70","author":"McGonagle","year":"2011","journal-title":"Ann. Rheum. Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1038\/oby.2011.397","article-title":"Obesity and pain are associated in the United States","volume":"20","author":"Stone","year":"2012","journal-title":"Obesity"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1002\/acr.21710","article-title":"Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: A long-term followup from disease onset","volume":"65","author":"Ajeganova","year":"2013","journal-title":"Arthritis Care Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.rdc.2012.10.004","article-title":"Epidemiology of osteoarthritis","volume":"39","author":"Neogi","year":"2013","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/rheumatology\/keq334","article-title":"Comorbidity affects all domains of physical function and quality of life in patients with rheumatoid arthritis","volume":"50","author":"Radner","year":"2011","journal-title":"Rheumatology"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e061474","DOI":"10.1136\/bmjopen-2022-061474","article-title":"Minimal disease activity and remission in patients with psoriatic arthritis with elevated body mass index: An observational cohort study in the Swiss Clinical Quality Management cohort","volume":"12","author":"Burkard","year":"2022","journal-title":"BMJ Open"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1002\/acr.21711","article-title":"Obesity and the prediction of minimal disease activity: A prospective study in psoriatic arthritis","volume":"65","author":"Peluso","year":"2013","journal-title":"Arthritis Care Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1038\/oby.2007.72","article-title":"Physical inactivity and obesity: A vicious circle","volume":"16","author":"Kaprio","year":"2008","journal-title":"Obesity"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"103357","DOI":"10.1016\/j.autrev.2023.103357","article-title":"Effect of body mass index on treatment response of biologic\/targeted-synthetic DMARDs in patients with rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis. A systematic review","volume":"22","author":"Gialouri","year":"2023","journal-title":"Autoimmun. Rev."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e70080","DOI":"10.1002\/iid3.70080","article-title":"Obesity and chronic inflammation: Implications for rheumatoid arthritis, spondyloarthritis, and ulcerative colitis","volume":"13","author":"Corrado","year":"2025","journal-title":"Immun. Inflamm. Dis."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"115281","DOI":"10.1016\/j.biopha.2023.115281","article-title":"Pharmacokinetics of obese adults: Not only an increase in weight","volume":"166","author":"Gouju","year":"2023","journal-title":"Biomed. Pharmacother."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Toussirot, E. (2020). The interrelations between biological and targeted synthetic agents used in inflammatory joint diseases, and obesity or body composition. Metabolites, 10.","DOI":"10.3390\/metabo10030107"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/cmi.2010.75","article-title":"Leptin in immuno-rheumatological diseases","volume":"8","author":"Vadacca","year":"2011","journal-title":"Cell Mol. Immunol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1186\/s13075-023-03187-4","article-title":"High BMI is associated with lower TNF-\u03b1 inhibitor serum trough levels and higher disease activity in patients with axial spondyloarthritis","volume":"25","author":"Arends","year":"2023","journal-title":"Arthritis Res. Ther."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jbspin.2018.03.007","article-title":"Impact of obesity on the efficacy of different biologic agents in inflammatory diseases: A systematic review and meta-analysis","volume":"86","author":"Shan","year":"2019","journal-title":"Jt. Bone Spine"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Singh, S., Facciorusso, A., Singh, A.G., Vande Casteele, N., Zarrinpar, A., Prokop, L.J., Grunvald, E.L., Curtis, J.R., and Sandborn, W.J. (2018). Obesity and response to anti-tumor necrosis factor-\u03b1 agents in patients with select immune-mediated inflammatory diseases: A systematic review and meta-analysis. PLoS ONE, 13, Erratum in PLoS ONE\u00a02018, 13, e0203499. https:\/\/doi.org\/10.1371\/journal.pone.0203499.","DOI":"10.1371\/journal.pone.0195123"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s13075-017-1372-3","article-title":"Impact of obesity on the response to tumor necrosis factor inhibitors in axial spondyloarthritis","volume":"19","author":"Micheroli","year":"2017","journal-title":"Arthritis Res. Ther."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1759720X211030792","DOI":"10.1177\/1759720X211030792","article-title":"Underweight and obesity are strong predictors of clinical outcomes in patients with ankylosing spondylitis: Data from the Smart-phone SpondyloArthritis Management System","volume":"13","author":"Hu","year":"2021","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_80","first-page":"145","article-title":"Obesity decreases clinical efficacy and levels of adalimumab in patients with ankylosing spondylitis","volume":"35","author":"Rosas","year":"2017","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1093\/mr\/road061","article-title":"Does obesity affect treatment response to secukinumab and survival in ankylosing spondylitis? Real-life data from the TURKBIO Registry","volume":"34","author":"Gulle","year":"2024","journal-title":"Mod. Rheumatol."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Dorta, A., Le\u00f3n-Suarez, P., Pe\u00f1a, S., Hern\u00e1ndez-D\u00edaz, M., Rodr\u00edguez-Lozano, C., Gonz\u00e1lez-D\u00e1vila, E., Hern\u00e1ndez-Hern\u00e1ndez, M.V., and D\u00edaz-Gonz\u00e1lez, F. (2022). Association of Gender, Diagnosis, and Obesity with Retention Rate of Secukinumab in Spondyloarthropathies: Results Form a Multicenter Real-World Study. Front. Med., 8.","DOI":"10.3389\/fmed.2021.815881"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"103864","DOI":"10.1016\/j.autrev.2025.103864","article-title":"Glucagon-Like Peptide-1 (GLP-1) receptor agonists in rheumatology: A review of current evidence and future directions","volume":"24","author":"Bilgin","year":"2025","journal-title":"Autoimmun. Rev."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"318","DOI":"10.5114\/reum\/170401","article-title":"Obesity in rheumatological practice","volume":"61","author":"Kozakowski","year":"2023","journal-title":"Reumatologia"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Molt\u00f3, A., and Nikiphorou, E. (2018). Comorbidities in Spondyloarthritis. Front. Med., 5.","DOI":"10.3389\/fmed.2018.00062"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s00296-025-05975-4","article-title":"Cardiovascular risk in axial spondyloarthritis: The interplay of inflammation, traditional risk factors, and management strategies","volume":"45","author":"Issakulova","year":"2025","journal-title":"Rheumatol. Int."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"105059","DOI":"10.1016\/j.jbspin.2020.07.008","article-title":"The relationship between weight status and metabolic syndrome in patients with rheumatoid arthritis and spondyloarthritis","volume":"88","author":"Giraud","year":"2021","journal-title":"Jt. Bone Spine"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"7498","DOI":"10.1038\/s41598-022-11640-8","article-title":"Persistence of C-reactive protein increased levels and high disease activity are predictors of cardiovascular disease in patients with axial spondyloarthritis","volume":"12","author":"Navarini","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.1007\/s10067-023-06655-z","article-title":"Cardiovascular risk in axial spondyloarthritis\u2014A systematic review","volume":"42","author":"Hintenberger","year":"2023","journal-title":"Clin. Rheumatol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1161\/HYPERTENSIONAHA.122.17982","article-title":"Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: A Review of Shared Cardiometabolic Risk Factors","volume":"79","author":"Peng","year":"2022","journal-title":"Hypertension"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1002\/iid3.391","article-title":"Inflammation initiates a vicious cycle between obesity and nonalcoholic fatty liver disease","volume":"9","author":"Luo","year":"2020","journal-title":"Immun. Inflamm. Dis."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"482","DOI":"10.5152\/ArchRheumatol.2025.25108","article-title":"The Association Between Obesity Indices and Non-Alcoholic Fatty Liver Disease in Patients with Ankylosing Spondylitis","volume":"40","author":"Kutluk","year":"2025","journal-title":"Arch. Rheumatol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"e70051","DOI":"10.1111\/cob.70051","article-title":"Relationship Between Sleep Duration and Overweight\/Obesity: A Comprehensive Overview of Meta-Analyses","volume":"16","author":"Benfica","year":"2026","journal-title":"Clin. Obes."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Bandinelli, F., Delle Sedie, A., Mallia, I., Mauro, I., Pecani, N., Carli, L., Esti, L., Di Carlo, M., Carotti, M., and Salaffi, F. (2025). Causes of Sleep Disturbance in Early ASAS Spondyloarthritis: A Retrospective Long-Term Experience. J. Pers. Med., 15.","DOI":"10.3390\/jpm15010031"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"e002912","DOI":"10.1136\/rmdopen-2022-002912","article-title":"Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms","volume":"9","author":"Frede","year":"2023","journal-title":"RMD Open"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"iv47","DOI":"10.1093\/rheumatology\/keaa246","article-title":"Prevalence and impact of comorbidities in axial spondyloarthritis: Systematic review and meta-analysis","volume":"59","author":"Zhao","year":"2020","journal-title":"Rheumatology"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1759720X20970028","DOI":"10.1177\/1759720X20970028","article-title":"Depression in patients with spondyloarthritis: Prevalence, incidence, risk factors, mechanisms and management","volume":"12","author":"Parkinson","year":"2020","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1038\/nri.2015.5","article-title":"The role of inflammation in depression: From evolutionary imperative to modern treatment target","volume":"16","author":"Miller","year":"2016","journal-title":"Nat. Rev. Immunol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s13075-016-0977-2","article-title":"Patient-reported impact of spondyloarthritis on work disability and working life: The ATLANTIS survey","volume":"18","author":"Ramonda","year":"2016","journal-title":"Arthritis Res. Ther."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/BOR.0000000000001090","article-title":"Nutritional guidance in spondyloarthritis: Confronting the evidence gap","volume":"37","author":"Ramonda","year":"2025","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Torres, L., Jonsson, C.A., Eliasson, B., Forsblad-d\u2019Elia, H., Landgren, A.J., Bilberg, A., Gjertsson, I., Larsson, I., and Klingberg, E. (2025). A six-month weight loss intervention is associated with significant changes in serum biomarkers related to inflammation, bone and cartilage metabolism in obese patients with psoriatic arthritis and matched controls. BMC Rheumatol., 9.","DOI":"10.1186\/s41927-025-00511-0"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Van den Bruel, K., Kulyk, M., Neerinckx, B., and De Vlam, K. (2025). Nutrition and diet in rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis: A systematic review. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1655165"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e001225","DOI":"10.1136\/rmdopen-2020-001225","article-title":"Association of body mass index on disease activity in axial spondyloarthritis: Systematic review and meta-analysis","volume":"6","author":"Liew","year":"2020","journal-title":"RMD Open"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1037\/amp0000517","article-title":"Lifestyle modification approaches for the treatment of obesity in adults","volume":"75","author":"Wadden","year":"2020","journal-title":"Am. Psychol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"105476","DOI":"10.1016\/j.jbspin.2022.105476","article-title":"The impact of diet on disease activity in spondyloarthritis: A systematic literature review","volume":"90","author":"Ortolan","year":"2023","journal-title":"Jt. Bone Spine"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s42358-022-00243-6","article-title":"Dietetic intervention in psoriatic arthritis: The DIETA trial","volume":"62","author":"Leite","year":"2022","journal-title":"Adv. Rheumatol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1186\/s13075-021-02600-0","article-title":"Mediterranean diet in axial spondyloarthritis: An observational study in an Italian monocentric cohort","volume":"23","author":"Ometto","year":"2021","journal-title":"Arthritis Res. Ther."},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Sun, N., Zhao, Y., Wang, J., Zhang, A., and He, Y. (2025). Intermittent fasting in osteoarthritis: From mechanistic insights to therapeutic potential. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1604872"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1136\/annrheumdis-2024-eular.3550","article-title":"AB1657-PARE Impact of Intermittent Fasting During Ramadan on Axial Spondyloarthritis: Patient Perceptions and Compliance","volume":"83","author":"Latifa","year":"2024","journal-title":"Ann. Rheum. Dis."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"230347","DOI":"10.5888\/pcd21.230347","article-title":"Weight Loss in Short-Term Interventions for Physical Activity and Nutrition Among Adults with Overweight or Obesity: A Systematic Review and Meta-Analysis","volume":"21","author":"Rotunda","year":"2024","journal-title":"Prev. Chronic Dis."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"e082973","DOI":"10.1136\/bmjopen-2023-082973","article-title":"Psychological interventions for weight reduction and sustained weight reduction in adults with overweight and obesity: A scoping review","volume":"14","author":"Hamer","year":"2024","journal-title":"BMJ Open"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/j.jand.2023.02.018","article-title":"Psychological and Behavioral Predictors of Weight Loss in the Reach Ahead for Lifestyle and Health-Diabetes Lifestyle Intervention Cohort","volume":"123","author":"Vakharia","year":"2023","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1210\/clinem\/dgz236","article-title":"Predicting Weight Loss Using Psychological and Behavioral Factors: The POUNDS LOST Trial","volume":"105","author":"Liu","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_114","first-page":"167","article-title":"The potential role of GLP-1 receptor agonists in the management of psoriatic disease: A scoping review","volume":"74","author":"Buonanno","year":"2025","journal-title":"Inflamm. Res. Off. J. Eur. Histamine Res. Soc."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1038\/s41584-025-01302-0","article-title":"Glucagon-like peptide-1 receptor agonists in arthritis: Current insights and future directions","volume":"21","author":"Karacabeyli","year":"2025","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1759720X241271886","article-title":"Metabolic syndrome and psoriatic arthritis: The role of weight loss as a disease-modifying therapy","volume":"16","author":"Williams","year":"2024","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Hsiao, Y.W., and Huang, Y.C. (2025). Glucagon-like peptide-1 receptor agonist therapy in patients with psoriasis is associated with a decreased risk of psoriatic arthritis: A retrospective cohort study using the TriNetX database. J. Am. Acad. Dermatol., advance online publication.","DOI":"10.1016\/j.jaad.2025.12.035"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1056\/NEJMoa2416394","article-title":"SURMOUNT-5 Trial Investigators Tirzepatide as Compared with Semaglutide for the Treatment of Obesity","volume":"393","author":"Aronne","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.7326\/ANNALS-25-03113","article-title":"Obesity, Weight Loss, and Knee Osteoarthritis: The Role of Glucagon-Like Peptide-1 Receptor Agonists","volume":"178","author":"Felson","year":"2025","journal-title":"Ann. Intern. Med."},{"key":"ref_120","unstructured":"(2026, January 12). Tirzepatide Added to Ixekizumab Improves Outcomes in Patients with PsA. Rheumatology Advisor. Available online: https:\/\/www.rheumatologyadvisor.com\/news\/tirzepatide-added-to-ixekizumab-improves-outcomes-in-patients-with-psa\/."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.ard.2025.05.596","article-title":"POS0209 impact of tirzepatide on musculoskeletal pain and risky analgesic use among non-diabetic individuals with overweight or obese body habitus: A propensity score-matched, active comparator, new user design study","volume":"84","author":"Challener","year":"2025","journal-title":"Ann. Rheum. Dis."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"e70103","DOI":"10.1002\/acr2.70103","article-title":"Effect of Glucagon-Like Peptide 1 Receptor Agonists on Patients with Rheumatoid Arthritis","volume":"7","author":"Kellner","year":"2025","journal-title":"ACR Open Rheumatol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/s13075-019-1869-z","article-title":"Consequences of bariatric surgery on outcomes in rheumatic diseases","volume":"21","author":"Lespessailles","year":"2019","journal-title":"Arthritis Res. Ther."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s42358-019-0050-3","article-title":"Axial Spondyloarthritis after bariatric surgery: A 7-year retrospective analysis","volume":"59","author":"Libanori","year":"2019","journal-title":"Adv. Rheumatol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1136\/ard-2022-223296","article-title":"ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update","volume":"82","author":"Ramiro","year":"2023","journal-title":"Ann. Rheum. Dis."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"100298","DOI":"10.1016\/j.ocarto.2022.100298","article-title":"Recommendations for weight management in osteoarthritis: A systematic review of clinical practice guidelines","volume":"4","author":"Lim","year":"2022","journal-title":"Osteoarthr. Cartil. Open"},{"key":"ref_127","unstructured":"(2026, April 01). Mediterranean Diet and Disease Activity in Axial Spondyloarthritis Receiving Biologic Therapy. Clinicaltrials.gov, Available online: https:\/\/clinicaltrials.gov\/study\/NCT07170384."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"600","DOI":"10.21873\/invivo.14224","article-title":"Anti-inflammatory Pathways of Novel Anti-diabetic Therapies. A Literature Review","volume":"40","author":"Cismaru","year":"2026","journal-title":"In Vivo"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.3899\/jrheum.2024-0939","article-title":"Unmet Needs in Spondyloarthritis: Pathogenesis, Clinical Trial Design, and Nonpharmacologic Therapy","volume":"51","author":"Coates","year":"2024","journal-title":"J. Rheumatol."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"71","DOI":"10.2165\/11318100-000000000-00000","article-title":"Effect of obesity on the pharmacokinetics of drugs in humans","volume":"49","author":"Hanley","year":"2010","journal-title":"Clin. Pharmacokinet."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1080\/14712598.2022.1998448","article-title":"Cardiometabolic comorbidity in the selection of treatment in spondyloarthritis: One step closer to truly personalized medicine?","volume":"21","author":"Queiro","year":"2021","journal-title":"Expert Opin. Biol. Ther."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s13075-019-1810-5","article-title":"Weight loss improves disease activity in patients with psoriatic arthritis and obesity: An interventional study","volume":"21","author":"Klingberg","year":"2019","journal-title":"Arthritis Res. Ther."}],"container-title":["Metabolites"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-1989\/16\/5\/347\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T14:27:20Z","timestamp":1779719240000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-1989\/16\/5\/347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":132,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["metabo16050347"],"URL":"https:\/\/doi.org\/10.3390\/metabo16050347","relation":{},"ISSN":["2218-1989"],"issn-type":[{"value":"2218-1989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]}}}