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Obesity Impact RA — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisObesity Impact RASCE Rheumatology

A 42-year-old woman with established rheumatoid arthritis has a BMI of 35 kg/m². Her pharmacological treatment is being optimised, and she asks whether obesity affects rheumatoid arthritis outcomes. Which statement best reflects the available evidence?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Obesity is associated with higher disease activity, lower target attainment and reduced TNF-inhibitor effectiveness.

Explanation lettering: C = shown as A · A = shown as B · B = shown as C

D is correct. In RA, obesity is associated with lower remission and treatment-target attainment, higher composite disease-activity measures and worse patient-reported physical function. A systematic review also found reduced TNF-inhibitor effectiveness with increasing BMI; this association appears more pronounced for TNF inhibitors than for several other targeted therapies. Obesity is therefore neither irrelevant nor solely a cause of mechanical pain, excluding B and E. Although some studies report less radiographic progression in patients with obesity, this apparent paradox does not translate into better overall clinical outcomes, so C is incorrect. Weight management should form part of comprehensive RA care but does not replace treat-to-target DMARD optimisation.

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;22:103357. https://pubmed.ncbi.nlm.nih.gov/37150489/