ArticleArthritis & rheumatology (Hoboken, N.J.)2015
Weight Loss, the Obesity Paradox, and the Risk of Death in Rheumatoid Arthritis.
Article in Arthritis & rheumatology (Hoboken, N.J.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 69 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
69 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effect of bariatric and metabolic surgery on rheumatoid arthritis outcomes: A systematic review.PloS one · 2023Pooled it
- Decrements of body mass index are associated with poor outcomes of idiopathic pulmonary fibrosis patients.PloS one · 2019Trial
- Semaglutide for primary prevention of major adverse cardiac and cerebrovascular events in patients with type 2 diabetes and comorbid rheumatoid arthritis: a target-trial emulation.European heart journal. Cardiovascular pharmacotherapy · 2026Article
- Performance of the Predicting Risk of Cardiovascular Disease Events Calculator in Rheumatoid Arthritis.Arthritis & rheumatology (Hoboken, N.J.) · 2026Article
- Long-term dynamic effect of body mass index on adverse cardiovascular outcomes with targeted maximum likelihood estimation method: result from the KNOW-CKD study.Scientific reports · 2026Article
- Adipokines and Associations With Incident Osteoporotic Fracture in Patients With Rheumatoid Arthritis.Arthritis care & research · 2026Article
- Multimorbidity Patterns and Obesity Among Americans Turning Forty.American journal of health promotion : AJHP · 2026Article
- The prevalence of coronary artery disease in rheumatoid arthritis patients in Palestine: a cross-sectional study.BMC rheumatology · 2026Article
- Metabolic Consequences of Rheumatoid Arthritis.Arthritis care & research · 2025Review
- Longitudinal patterns of obesity index changes and risk of incident rheumatoid arthritis: evidence from a population-based cohort.Arthritis research & therapy · 2025Article
- The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index exhibits an L-shaped association with all-cause mortality in rheumatoid arthritis patients: a retrospective cohort study.BMC rheumatology · 2025Article
- Metabolic Syndrome, Adipokines, and Response to Advanced Therapies in Rheumatoid Arthritis.Arthritis & rheumatology (Hoboken, N.J.) · 2025Article
- The Veterans Affairs Rheumatoid Arthritis Registry: A unique population in rheumatoid arthritis research.Seminars in arthritis and rheumatism · 2025Review
- Development and validation of an interpretable machine learning model for predicting low muscle mass in patients with rheumatoid arthritis: a multicenter study.Frontiers in medicine · 2025Article
- Rheumatic diseases and metabolism: where centre and periphery meet.Nature reviews. Rheumatology · 2024Review
- Hyperleptinemia as a Marker of Various Phenotypes of Obesity and Overweight in Women with Rheumatoid Arthritis and Systemic Lupus Erythematosus.Doklady. Biochemistry and biophysics · 2024Article
- Article
- Observational
- Lower body mass and lower adiposity are associated with differential responses to two treatment strategies for rheumatoid arthritis.Annals of the rheumatic diseases · 2024Article
- Article
9 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveIn 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.
methodsOur 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.
resultsIn a sample of 1,674 patients, 312 deaths occurred over 9,183 person-years. A loss in BMI of ≥1 kg/m(2) 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] 1.53-2.59, P < 0.001). This association remained significant in a subsample analysis adjusting for C-reactive protein and physical function (HR 1.81, 95% CI 1.36-2.41, P < 0.001). Weight loss at an annualized rate of ≥3 kg/m(2) was associated with the greatest risk of death (HR 2.49, 95% CI 1.73-3.57, P < 0.001). Low BMI (<20 kg/m(2) ) in patients with a history of obesity (>30 kg/m(2) ) was associated with the greatest risk (HR 8.52, 95% CI 4.10-17.71, P < 0.001).
conclusionWeight 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.
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