title: Predictors of longterm changes in body mass index in rheumatoid arthritis.
abstract: OBJECTIVE
  Low body mass index (BMI) is a risk factor for poor longterm outcomes in rheumatoid arthritis (RA). The purpose of this study was to identify factors associated with longterm changes in BMI.
  
  
  METHODS
  Subjects with RA from the Veterans Affairs (VA) Rheumatoid Arthritis (VARA) Registry (n = 1474) were studied. Information on inflammatory markers, presence of erosions, and smoking status were extracted from the VARA database. BMI was extracted from VA electronic medical records within 14 days of each visit date. VA pharmacy records were queried to identify prescriptions for specific RA therapies within 1 month of the visit date. We used robust generalized estimating equations marginal regression models to calculate independent associations between clinical variables and BMI over time. Similar models determined predictors of change in weight and risk of weight loss over the subsequent study observation period.
  
  
  RESULTS
  Increasing age, active smoking, and the presence of erosions at baseline were associated with lower BMI. Weight decreased over time among older adults. Factors associated with greater reductions in BMI over time and a greater risk of weight loss were higher inflammatory markers, smoking, older age, higher BMI, and less subsequent improvement in inflammation. Methotrexate use was associated with a lower risk of weight loss. The use of prednisone or anti-tumor necrosis factor therapies was not associated with change in BMI or the risk of weight loss independent of other factors.
  
  
  CONCLUSIONS
  Greater age, greater inflammatory activity, and active smoking are associated with greater weight loss in RA over time.
authors.affiliation: From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center. bakerjo@uphs.upenn.edu.
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Baker
authors.affiliation: From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Cannon
authors.affiliation: From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center.
authors.forename: Said
authors.initials: S
authors.lastname: Ibrahim
authors.affiliation: From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center.
authors.forename: Candace
authors.initials: C
authors.lastname: Haroldsen
authors.affiliation: From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center.
authors.forename: Liron
authors.initials: L
authors.lastname: Caplan
authors.affiliation: From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center.
authors.forename: Ted R
authors.initials: TR
authors.lastname: Mikuls
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D015992:Body Mass Index; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D016014:Linear Models; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D011237:Predictive Value of Tests; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012042:Registries; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D015431:Weight Loss
chemical_list: D018501:Antirheumatic Agents; D011241:Prednisone; D008727:Methotrexate
keywords: BODY MASS INDEX; CACHEXIA; INFLAMMATION; RHEUMATOID ARTHRITIS
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