The equivocal opposite effects of lower and higher body mass index at diagnosis on radiographic joint damage progression in early rheumatoid arthritis: an inception cohort study over 15 years
Authors' conclusion
BMI is one of the determinants of radiographic progression in early RA. Lower and higher BMI have opposite effects on radiographic progression.
Study context
- Population
- Early rheumatoid arthritis (RA) inception cohort (Better AntiRheumatic FarmacoTherapy cohort)
- Participants
- 1,813 participants
- Exposure
- Baseline Body Mass Index (BMI) categories vs normal weight
- Outcome
- Radiographic damage progression (mTSS, ES, JSN) of hands and feet
- Follow-up
- 15 years
Methodological detailsobservational, 15-year follow-up, curve estimation regression, multivariate mixed models
- Observational
- 15-year follow-up
- Curve estimation regression
- Multivariate mixed models
Main finding
As reported in the abstract
mTSS progression per year
Beta
0.946 per year
95% CI 0.902–0.995P = 0.029
BMI ≥30 kg/m² · less severe mTSS progression
Beta
1.091 per year
95% CI 1.019–1.169P = 0.014
BMI ≤20 kg/m² · more joint damage
Observational data: associations, not effects.
Further findings
Erosion score (ES), joint space narrowing (JSN) and ACPA-positive patients
- Findings confirmed in separate analyses of ES and JSN, and in ACPA-positive patients
Association of mTSS change with CRP, ESR and Disease Activity Score (DAS28)
- Effect sizes declined over time and varied across BMI strata, indicating effect modification by BMI
BMI ≥27 kg/m²
- Results largely mirrored those in BMI ≥30 kg/m²
Original publication
The equivocal opposite effects of lower and higher body mass index at diagnosis on radiographic joint damage progression in early rheumatoid arthritis: an inception cohort study over 15 years. RMD Open. Published 31 July 2025. doi:10.
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