TOPLINE:
Higher levels of body fat and visceral adipose tissue are associated with increased functional disability and reduced spinal mobility in patients with axial spondyloarthritis (axSpA) receiving biologic disease-modifying antirheumatic drugs (bDMARDs).
METHODOLOGY:
- Research showed that patients with axSpA respond poorly to tumor necrosis factor inhibitors if they have a high body mass index (BMI) or obesity; however, studies delving into the association between biologic therapy and body composition are limited.
- Researchers investigated the association between body composition evaluated by bioimpedance analysis and disease activity, physical function, and mobility in 74 patients with axSpA (mean age, 36.5; 71.6% men) at 6 months and 1 year after initiating bDMARDs.
- These participants from the German Spondyloarthritis Inception Cohort presented with high disease activity despite previous treatment with nonsteroidal anti-inflammatory drugs and initiated bDMARD therapy between 2015 and 2019.
- Bath Ankylosing Spondylitis Disease Activity Index and Axial Spondyloarthritis Disease Activity Score were used to measure disease activity, while Bath Ankylosing Spondylitis Functional Index and Bath Ankylosing Spondylitis Mobility Index assessed physical function and spinal mobility, respectively.
- BMI, fat mass, fat mass index, and visceral adipose tissue (VAT) were used to determine body composition along with other parameters.
TAKEAWAY:
- Higher BMI (parameter estimates [β], 0.081; 95% CI, 0.016-0.145), fat mass (β, 0.037; 95% CI, 0.004-0.070), and fat mass index (β, 0.125; 95% CI, 0.031-0.219) were associated with worse physical function in the overall population.
- VAT was positively associated with reduced spinal mobility (β, 0.201; 95% CI, 0.071-0.332), particularly in men.
- In women, an increase in VAT was linked to worse disease activity and functional disability.
- Treatment with bDMARDs reduced all disease activity parameters but led to an increase in BMI and fat-related parameters, indicating that lifestyle modifications are also necessary to achieve the desired outcomes with bDMARD therapy.
IN PRACTICE:
“Overall, our findings highlight the importance of maintaining a healthy body weight and body composition — characterized by adequate lean mass and reduced FM [fat mass] — to improve physical function and quality of life in patients with SpA,” the authors wrote.
SOURCE:
The study was led by Valeria Rios Rodriguez, MD, department of gastroenterology, infectiology and rheumatology, Charité Universitätsmedizin Berlin, Germany. It was published online March 20, 2024, in Rheumatology (Oxford).
LIMITATIONS:
This study lacked a control group of patients with axSpA who did not receive biologics. It also did not include dietary habits and comorbidities such as hypertension or diabetes. Additionally, bioimpedance analysis was chosen as the method to assess body composition instead of dual-energy x-ray absorptiometry.
DISCLOSURES:
The study was funded by the German Federal Ministry of Education and Research and the Berlin Institute of Health. Some of the authors declared receiving personal fees, grants, and consulting fees from various pharmaceutical companies.
A version of this article appeared on Medscape.com.