title: Obesity Is Common in Axial Spondyloarthritis and Is Associated with Poor Clinical Outcome.
abstract: OBJECTIVE
  To assess the prevalence of overweight and obesity in a large cohort of patients with axial spondyloarthritis (axSpA) in comparison with the general population. To explore the relationship of body mass index (BMI) with clinical outcome in axSpA.
  
  
  METHODS
  Patients from the Groningen Leeuwarden Axial SpA cohort who visited the outpatient clinic in 2011/2012 were included in this cross-sectional analysis. Body weight, height, disease activity, physical function, and quality of life (QoL) were assessed. Patients were divided into normal weight (BMI < 25 kg/m(2)), overweight (BMI ≥ 25 to < 30 kg/m(2)), and obese (BMI ≥ 30 kg/m(2)). BMI data for the general population in the same demographic region, matched for age and sex, were obtained from the LifeLines Cohort Study.
  
  
  RESULTS
  Of the 461 patients with axSpA, 37% were overweight and 22% were obese. In the LifeLines cohort (n = 136,577), 43% were overweight and 15% were obese. Overweight and obese patients were older, had longer symptom duration, and had more comorbidities, especially hypertension. Further, obese patients had significantly higher disease activity, worse physical function, and worse QoL than overweight and normal weight patients (mean Bath Ankylosing Spondylitis Disease Activity Index 4.5, 3.5, 3.8; mean Ankylosing Spondylitis Disease Activity Score 2.8, 2.2, 2.3; median C-reactive protein 5, 3, 3 mg/l; median erythrocyte sedimentation rate 13, 8, 8 mm/h; median Bath Ankylosing Spondylitis Functional Index 5.2, 2.9, 2.9; median Ankylosing Spondylitis QoL Questionnaire 8, 4, 5, respectively). After adjustment for potential confounders, obesity proved to be an independent predictor of worse clinical outcome.
  
  
  CONCLUSIONS
  In this large observational cohort study, obesity is more common in axSpA than in the general population and it is associated with worse clinical outcome.
authors.affiliation: From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden. f.maas@umcg.nl.
authors.forename: Fiona
authors.initials: F
authors.lastname: Maas
authors.affiliation: From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Arends
authors.affiliation: From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden.
authors.forename: Eveline
authors.initials: E
authors.lastname: van der Veer
authors.affiliation: From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden.
authors.forename: Freke
authors.initials: F
authors.lastname: Wink
authors.affiliation: From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden.
authors.forename: Monique
authors.initials: M
authors.lastname: Efde
authors.affiliation: From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden.
authors.forename: Hendrika
authors.initials: H
authors.lastname: Bootsma
authors.affiliation: From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Brouwer
authors.affiliation: From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; M. Efde, MD, Department of Rheumatology, Medical Center Leeuwarden; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden.
authors.forename: Anneke
authors.initials: A
authors.lastname: Spoorenberg
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D011379:Prognosis; D011788:Quality of Life; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: AXIAL SPONDYLOARTHRITIS; BODY MASS INDEX; DISEASE ACTIVITY; OBESITY