title: Association of morbid obesity with disability in early inflammatory polyarthritis: results from the Norfolk Arthritis Register.
abstract: OBJECTIVE
  Obesity has been associated with disease outcomes in inflammatory arthritis. This study aimed to investigate cross-sectionally the relationship between body mass index (BMI) and functional disability in a large inception cohort of patients with early inflammatory polyarthritis (IP).
  
  
  METHODS
  Patients age ≥16 years with ≥2 swollen joints for ≥4 weeks were recruited into the Norfolk Arthritis Register. At the initial assessment, clinical and demographic data were obtained, joints were examined, and height and weight were measured. Blood samples were taken to measure inflammatory markers and autoantibodies, and patients completed the Health Assessment Questionnaire (HAQ) to assess functional disability. Univariate and multivariate ordinal regression were used to examine the cross-sectional association between BMI and the HAQ. Multiple imputation using chained equations allowed inclusion of patients with missing variables.
  
  
  RESULTS
  A total of 1,246 patients were studied (median age 57 years). Of those patients, 782 patients (63%) were female and 303 (25%) were obese (BMI ≥30 kg/m(2) ). Morbid obesity (BMI ≥35 kg/m(2) ) was significantly associated with worse functional disability in the univariate and multivariate analysis with missing data imputed, adjusting for age, sex, symptom duration, smoking status, disease activity, autoantibodies, comorbidities, and treatment (multivariate odds ratio 1.87, 95% confidence interval 1.14-3.07).
  
  
  CONCLUSIONS
  Morbid obesity in patients with early IP is associated with worse HAQ scores. This should be taken into account in patient management and when interpreting the HAQ in clinical practice.
authors.affiliation: University of Manchester, Manchester, UK.
authors.forename: J H
authors.initials: JH
authors.lastname: Humphreys
authors.forename: S M M
authors.initials: SM
authors.lastname: Verstappen
authors.forename: H
authors.initials: H
authors.lastname: Mirjafari
authors.forename: D
authors.initials: D
authors.lastname: Bunn
authors.forename: M
authors.initials: M
authors.lastname: Lunt
authors.forename: I N
authors.initials: IN
authors.lastname: Bruce
authors.forename: D P M
authors.initials: DP
authors.lastname: Symmons
mesh_terms: D000368:Aged; D001168:Arthritis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D001323:Autoantibodies / Q000097:blood; D015992:Body Mass Index; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004739:England; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D012042:Registries; D012720:Severity of Illness Index
chemical_list: D001323:Autoantibodies