It’s a known fact that obesity is linked with many other medical conditions, the most common of which are cardiovascular diseases and diabetes. It’s also a known fact that the prevalence of obesity in the United States is rising steadily. It isn’t common knowledge, however, that obesity and rheumatoid arthritis are two conditions that are also closely linked.
People who suffer from rheumatoid arthritis generally tend to be less physically active, as compared to people who suffer from non-inflammatory arthritis, mainly due to the swelling, stiffness, and deformity, as well as the pain associated with it. This, in turn, makes them even more prone to develop obesity. It’s even worse for rheumatoid arthritis patients who are already obese since they encounter more difficulties moving around. Read on to find out how obesity affects people with rheumatoid arthritis.
#1 Rheumatoid Cachexia
Rheumatoid Cachexia is a condition that is also referred to as muscle wasting. It means that people who suffer from rheumatoid arthritis lose muscle mass and muscle strength because of their condition. What’s even sadder about rheumatoid cachexia is that it targets fat-free mass.
Moreover, people who suffer from rheumatoid arthritis lose thirteen to fifteen percent of their body cell mass. This is problematic because as little as a 5% loss will already result in visibly reduced muscle strength and higher risks of infections. Furthermore, a body cell mass loss of 40% is already associated with death. Rheumatoid cachexia itself does not cause death but it makes the patient susceptible to many infections and diseases that lead to morbidity.
For rheumatoid arthritis patients who are already obese, rheumatoid cachexia can significantly increase the risks of cardiovascular diseases. This is because cachexia eats away the skeletal muscles and leaves the fat mass behind. Thus, it leaves the patient with a higher body fat index, which then leads to higher risks of stroke, cancer, diabetes, and other heart diseases.
The situation is different but no less dire for rheumatoid patients who are already thin, to begin with. Since these patients do not have any excess skeletal muscle mass that they can afford to lose, when rheumatoid cachexia attacks, it can lead to extreme frailty and a significant decline in muscle strength.
Rheumatoid cachexia also increases their risks of falling and fractures. Either way, whether the patient is obese or thin, rheumatoid cachexia, when unchecked, can lead to disabilities which can further limit the patient’s mobility.
#2 Reduced Responsiveness To Treatment
One study investigated the relationship between body mass index and responsiveness to infliximab, which is a medication used for the treatment of autoimmune diseases such as rheumatoid arthritis, psoriasis, and Crohn’s disease. Eighty-nine patients suffering from rheumatoid arthritis participated in the study.
Unfortunately, those who had a high body mass index did not respond well to the medication even after 16 weeks of treatment. Only half of those who had BMI >30 kg/m2 showed positive response to the medication and improvement in their condition whereas for those who had BMI levels of 20–30, 75% showed improvements.
Other studies also confirmed that obese rheumatoid arthritis patients showed less responsiveness to treatments. Different medications were used in the various studies and the test periods also differed, some were only for 3 months while others were for 6 months. The common result was that obese rheumatoid arthritis patients always showed poorer results. However, the mechanism by which adipose tissues or fats interfere with rheumatoid arthritis treatments is still not clear so further studies are still needed.
#3 The Obesity Paradox
Despite the fact that obesity is associated with many serious medical conditions, in rheumatoid arthritis patients, obesity has a positive side to it. A recent study analyzed the cause of death of male United States veterans who had rheumatoid arthritis.
The top causes of mortality were cardiovascular diseases, cancer, and respiratory disease. Surprisingly, obesity is not among the factors linked with all-cause mortality which included smoking, prednisone use, and older age.
With regard to body mass index, the study showed that those who had a BMI greater than 25 but less than 30 kg/m2 appeared to have lower risks of death due to a cardiovascular disease while those who had less than 20 kg/m2 BMI were more likely to die due to respiratory diseases.
What was surprising was that there appeared a protective association for those who had a BMI of 30-35 kg/m2, the BMI range for class 1 obesity. This means that participants in this BMI range had significantly lower associations with all-cause mortality, cardiovascular disease-related mortality, cancer-related mortality, and even respiratory-related mortality.
Another study attempted to explain the obesity paradox to better understand why obese rheumatoid patients appeared to have lower risks of early death. The researchers point to change in weight and body mass compositions as possible explanations. The study highlights the significance of rapid weight loss within a one-year period as a predictor of mortality for rheumatoid arthritis patients.
This means that rheumatoid patients who may have been obese previously but experienced sudden and unplanned rapid weight loss over a year, have higher risks of dying. But when an obese rheumatoid patient does not go through the same rapid weight loss, his original risks of mortality are not compounded by the additional risks of dying associated with sudden loss of weight.
In short, it’s not that being obese protects these patients from early death, but that sudden rapid loss of weight, which makes the patient no longer obese, significantly increases the risks of early death.
Simple And Easy Exercises
Although it may be doubly difficult for obese people who have rheumatoid arthritis to engage in physical activities, there are a few easy exercises they can benefit from. Simple stretching like reaching for the toes will not put a lot of pressure on the joints but instead, help with flexibility and improve range of motion.
Walking, yoga, and tai chi are also great ways to burn off extra fat and improve balance and flexibility. There’s no need to be intense about it, but regular exercise does have positive effects on both obesity and rheumatoid arthritis so these exercises can really help a lot.