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The influence of BMI and smoking at disease onset on long-term joint damage measured with the RAAD score in patients with rheumatoid arthritis

(2016) Boes, E.S.

Introduction: after the development of new effective medication and the introduction of “treat-to-target” strategies directed at obtaining remission, the prognosis of RA greatly improved. Remarkably, obesity is named as a predictor of less radiographic progression. The literature is not clear about the relation between body mass index (BMI) and long-term joint damage. Little evidence about the long-term effect of smoking on joint damage is available. Time consuming radiographic scoring methods, such as the Sharp van der Heijde (SHS) and Larsen score, are frequently used in clinical research to evaluate joint damage of hands and feet. In order to have an easy applicable instrument to measure joint damage, Zijlstra et al. developed the RAAD score in 2002. A high correlation between the RAAD score and the SHS has been found. The present study investigated whether BMI and smoking at the moment of diagnosis are related with irreversible joint damage at long-term, measured with the RAAD score.
Patients and methods: the research population consists of all patients who received treatment for RA in the ZGT from January 1996 until December 2015. From this population patients with a RAAD score, determined between 2014 and April the first of 2016, and a disease duration of at least five years at the moment of the RAAD score were included. Baseline data were collected through retrospective record research and through verifying information during an outpatient visit. Smoking at disease onset was categorized in three groups: current smoker, former smoker, non smoker. Mann Whitney U tests, Spearman’s correlations, Kruskal-Wallis tests and multivariate regression analysis were performed.
Results: baseline characteristics study population (n=521): 67.8% woman, mean (SD) age in years 49.0 (13.7), mean (SD) BMI in kg/m2 25.7 (3.9), 79.5% RF positive, 72.6% anti-CCP positive, 36.8% non smoker, 28.4% former smoker, 34.8% smoker. Median [IQR] RAAD score was 2.0 [0-6.0]. A significant, weak correlation between BMI and the RAAD score (correlation coefficient -0.14, p=0.003) was found. No significant difference in RAAD score was found between patients with different smoking status. Obviously, the RAAD score was correlated with disease duration, irreversible damage can only increase. Disease duration was correlated with BMI. There was an increasing trend in BMI at disease during the decades. When corrected for this trend, through adjusting for disease duration, no significant correlation was found between BMI and the RAAD score.
Conclusion: BMI and smoking status at the moment of diagnosis of RA are not related with irreversible joint damage at long-term as measured with the RAAD score, when adjusted for disease duration. For the trend in BMI throughout the decades was corrected with disease duration.




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ID 3345
Moeder ID 3084
Volgorde Boes, E.S.
Naam BoesES
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2016/BoesES/
Gemaakt op: 2017-02-22 10:31:27
Gemodificeerd op: 2017-02-22 10:31:27
Digitaal ID 58ad687e54cb9
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel The influence of BMI and smoking at disease onset on long-term joint damage measured with the RAAD score in patients with rheumatoid arthritis
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 32
Publicatiejaar 2016
Taal en
Engelse samenvatting Introduction: after the development of new effective medication and the introduction of “treat-to-target” strategies directed at obtaining remission, the prognosis of RA greatly improved. Remarkably, obesity is named as a predictor of less radiographic progression. The literature is not clear about the relation between body mass index (BMI) and long-term joint damage. Little evidence about the long-term effect of smoking on joint damage is available. Time consuming radiographic scoring methods, such as the Sharp van der Heijde (SHS) and Larsen score, are frequently used in clinical research to evaluate joint damage of hands and feet. In order to have an easy applicable instrument to measure joint damage, Zijlstra et al. developed the RAAD score in 2002. A high correlation between the RAAD score and the SHS has been found. The present study investigated whether BMI and smoking at the moment of diagnosis are related with irreversible joint damage at long-term, measured with the RAAD score.
Patients and methods: the research population consists of all patients who received treatment for RA in the ZGT from January 1996 until December 2015. From this population patients with a RAAD score, determined between 2014 and April the first of 2016, and a disease duration of at least five years at the moment of the RAAD score were included. Baseline data were collected through retrospective record research and through verifying information during an outpatient visit. Smoking at disease onset was categorized in three groups: current smoker, former smoker, non smoker. Mann Whitney U tests, Spearman’s correlations, Kruskal-Wallis tests and multivariate regression analysis were performed.
Results: baseline characteristics study population (n=521): 67.8% woman, mean (SD) age in years 49.0 (13.7), mean (SD) BMI in kg/m2 25.7 (3.9), 79.5% RF positive, 72.6% anti-CCP positive, 36.8% non smoker, 28.4% former smoker, 34.8% smoker. Median [IQR] RAAD score was 2.0 [0-6.0]. A significant, weak correlation between BMI and the RAAD score (correlation coefficient -0.14, p=0.003) was found. No significant difference in RAAD score was found between patients with different smoking status. Obviously, the RAAD score was correlated with disease duration, irreversible damage can only increase. Disease duration was correlated with BMI. There was an increasing trend in BMI at disease during the decades. When corrected for this trend, through adjusting for disease duration, no significant correlation was found between BMI and the RAAD score.
Conclusion: BMI and smoking status at the moment of diagnosis of RA are not related with irreversible joint damage at long-term as measured with the RAAD score, when adjusted for disease duration. For the trend in BMI throughout the decades was corrected with disease duration.
Nederlandse samenvatting Introductie: na de introductie van nieuwe effectieve medicatie en op remissie gerichte behandeling is de prognose van reumatoïde artritis (RA) sterk verbeterd. Opmerkelijk is dat obesitas genoemd wordt als mogelijke voorspeller van minder gewrichtsschade op lange termijn. De literatuur is echter niet eenduidig over de relatie tussen body mass index (BMI) en lange termijn gewrichtsschade. Over het effect van roken op lange termijn gewrichtsschade is weinig bekend en resultaten spreken elkaar tegen. Bewerkelijke radiografische scoringsmethodes, zoals de Sharp van der Heijde score (SHS) en Larsen score, worden in klinische studies gebruikt ter evaluatie van gewrichtsschade. De Rheumatoid Arthritis Articular Damage (RAAD) score werd in 2002 geïntroduceerd als eenvoudig toepasbaar meetinstrument voor gewrichtsschade. De RAAD score heeft een hoge correlatie met de SHS. In deze studie is onderzocht of BMI en roken ten tijde van het stellen van de diagnose van de ziekte samenhangen met irreversibele gewrichtsschade op lange termijn, gemeten met de RAAD score.
Patiënten en methode: de onderzoekspopulatie betreft alle patiënten die behandeld zijn voor RA in de Ziekenhuisgroep Twente van januari 1996 tot en met december 2015. Uit deze populatie werden patiënten geïncludeerd met een ziekteduur van minstens vijf jaar ten tijde van de RAAD score, bepaald in de periode juli 2014 tot april 2016. Baselinekarakteristieken werden retrospectief verzameld uit gedigitaliseerde dossiers en door navraag bij patiënten. Rookstatus op baseline is ingedeeld in de groepen: nooit gerookt, gestopt met roken, rookt. Mann Whitney U testen, Spearman’s correlaties, Kruskal-Wallis testen en multivariate regressie analyses zijn uitgevoerd.
Resultaten: baselinekarakteristieken studie populatie (n=521): 67.8% vrouw, gemiddelde (SD) leeftijd in jaren 49.0 (13.7), gemiddelde (SD) BMI in kg/m2 25.7 (3.9), 79.5% reumafactor positief, 72.6% anti-CCP positief, 36.8% nooit gerookt, 28.4% gestopt met roken, 34.8% rookt. De mediane [IQR] RAAD score was 2.0 [0-6.0]. Er was een significante, zwakke correlatie tussen BMI en de RAAD score (correlatie coëfficiënt -0.14, p=0.003). Er was geen significant verschil in de RAAD score tussen de rookstatus groepen. Ziekteduur was vanzelfsprekend gecorreleerd met de RAAD score, irreversibele schade kan per definitie enkel toenemen. Ziekteduur was gecorreleerd aan BMI. Gedurende de decades was er in deze onderzoekspopulatie een toename van BMI en een geringe afname van het aantal rokers bij het begin van de ziekte. Uit multivariate analyse, waarin gecorrigeerd werd voor ziekteduur, bleek dat BMI niet gecorreleerd was aan de RAAD score.
Conclusie: BMI en rookstatus bij het begin van RA zijn niet gerelateerd aan gewrichtsschade op lange termijn zoals gemeten met de RAAD score, wanneer gecorrigeerd voor ziekteduur. Met ziekteduur is ook gecorrigeerd voor de trend in BMI gedurende de afgelopen decaden.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Boes, E.S.
Begeleider(s) opleidingsinstelling Supervisor:; Bernelot Moens, Dr. H.J.; Ziekenhuisgroep Twente, Department of Rheumatology
Auteur(s) Boes, E.S.


 
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