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Obesity and Biologic Response — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisObesity and Biologic ResponseSCE Rheumatology

A 55-year-old man with rheumatoid arthritis has persistent disease activity despite optimised methotrexate therapy. His BMI is 38 kg/m². He asks whether obesity is relevant to the expected effectiveness of biologic therapy. Which statement best reflects the current evidence?

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Reveal the answer and explanation

Correct answer: D — Higher BMI is associated with reduced response most consistently for TNF inhibitors, while its effect varies across other biologic classes.

Explanation lettering: E = shown as B · D = shown as C · C = shown as D · B = shown as E

C is correct. Obesity is associated with a lower probability of response or remission in RA, with the most consistent class-specific evidence concerning TNF inhibitors. A systematic review found the adverse association to be more pronounced for TNF inhibitors than for other biologic or targeted synthetic DMARDs; results for non-TNF therapies are less uniform, and evidence remains limited for some agents. This is an association rather than an absolute contraindication or a rule determining treatment selection. BMI is therefore neither irrelevant nor an equal predictor across every class, excluding A and B. Weight-based dosing does not abolish the association: poorer response has also been reported with weight-adjusted infliximab, excluding D. There is no evidence that obesity improves response, excluding E.

Reference: Gialouri CG et al. Effect of body mass index on treatment response of biologic/targeted-synthetic DMARDs in patients with rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis: a systematic review. Autoimmunity Reviews. 2023;22(7):103357. https://pubmed.ncbi.nlm.nih.gov/37150489/