Targeting Obesity in Rheumatic Disease Patients Save
Sattar et al. has published an informative overview of the effect of obesity on rheumatic and musculoskeletal diseases (RMDs). They estimate that nearly 70% of RMD patients are overweight or obese.
This viewpoint article in the Annals of Rheumatic Disease covers the effects of obesity on disease risk, disease progression, quality of life, physical function, therapeutic responses and drug toxicity or disease complications.
Obesity is a primary co-conspirator amongst a number of RMD comorbidities, including hypertension, cardiovascular disease, diabetes, metabolic syndrome, steatotic liver disease, depression, osteoarthritis and fibromyalgia.
Important advances in obesity management offer additional means by which we can further improve the outcomes of RMD patients. Future trials testing their coadministration with current or future therapies are awaited. The authors state that it is "timely for the rheumatology community to take up the baton and design and conduct robust weight loss trials to test many of the issues discussed herein. The potential benefits for many patients living with inflammatory RMDs and obesity are considerable". We need to address the importance and impact of obesity on RMD patients. As such, the title of this review article exclaims it is "time to act".
Key points from this article:
- We have significantly reduced disease mortality by disease control and smoking cessation; but we have not effectively addressed the problem of obesity
- Obesity begets more type 2 diabetes, HTN, cardiovascular disease, systemic inflammation, biomechanical difficulty, osteoarthritis, mental health problems, more infections, and more metabolic dysfunction-associated steatotic liver disease (MASLD)
- Weight loss can have disease modifying effects in obese RMD patients
- Potential impact of weight loss in RMD patients
- Less incidence of RMD
- Reduced disease severity
- Improved response to DMARDs
- Reduced adverse effects (less infections?)
- Improved activities of daily living
- Reduced comorbidities
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I have been pushing very low carbohydrate diets for 15 years and in the last 5 years strict ketogenic diets in patients. Seronegaitve spondyloarthritis responds particularly well to this approach with a significant percentage of patints with B27 going into remission off of meds. All patients from RA, to PSA to OA require substantially less medication to control disease. This is not a minor effect. Compliance is challenging but there are a growing number of compliance resources available as well as ketometers and glucometers to aid with compliance and guide dietary decisions.
Disclosures
The author has no conflicts of interest to disclose related to this subject
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