Document Detail

Body mass index and clinical response to infliximab in rheumatoid arthritis.
MedLine Citation:
PMID:  21279992     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Adipose tissue has immunomodulating effects in rheumatoid arthritis (RA), although the exact role is, at present, unclear. The purpose of this study was to determine whether body mass index (BMI) affects response to infliximab in RA patients investigated prospectively.
METHODS: In 89 patients with active RA, the BMI was calculated before initiation of infliximab treatment (3 mg/kg intravenously). After 16 weeks of treatment, changes in disease activity were assessed with the Disease Activity Score in 28 joints (DAS28).
RESULTS: The mean ± SD BMI was 26 ± 5 kg/m(2) (range 17-42). The BMI correlated positively with the DAS28 at baseline (r = 0.34, P = 0.001). Since selection of study patients according to DAS28 values could influence the clinical response to tumor necrosis factor (TNF) blockade due to regression to the mean because the clinical response is itself based on the change in the DAS28 values, analysis of covariance was used to correct for the baseline DAS28. A highly significant, negative association between the BMI and the absolute decrease in the DAS28 after 16 weeks (P = 0.001) was found also when adjusted for anti-citrullinated protein antibodies.
CONCLUSION: Although the infliximab dosage is based on body weight, RA patients with a high BMI responded less well to infliximab, a finding that held true when adjusted for the baseline DAS28 or anti-citrullinated protein antibody status. These results support the notion that adipose tissue may be involved in the pathophysiology of RA and could have implications for other immune-mediated inflammatory conditions treated with TNF antagonists.
Ruth Klaasen; Carla A Wijbrandts; Danielle M Gerlag; Paul P Tak
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  63     ISSN:  1529-0131     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-31     Completed Date:  2011-03-08     Revised Date:  2011-10-14    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  359-64     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 by the American College of Rheumatology.
Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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MeSH Terms
Antibodies, Monoclonal / therapeutic use*
Antirheumatic Agents / therapeutic use*
Arthritis, Rheumatoid / drug therapy*,  physiopathology,  radiography
Body Mass Index*
Health Status
Joints / drug effects,  physiopathology
Middle Aged
Prospective Studies
Severity of Illness Index
Treatment Outcome
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Antirheumatic Agents; 0/infliximab
Comment In:
Arthritis Rheum. 2011 Sep;63(9):2833-4; author reply 2834   [PMID:  21618200 ]
Nat Rev Rheumatol. 2011 Feb;7(2):72   [PMID:  21374851 ]

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