Obesity is associated with pain and impaired mobility despite therapy in systemic lupus erythematosus
Alexander Borg, Julius Lindblom, Alvaro Gómez, Ameneh Soltani, Yvonne Enman, Emelie Heintz, Malin Regardt, David Grannas, Sharzad Emamikia, Ioannis Parodis
Abstract
Objective To investigate whether abnormal BMI is associated with health-related quality of life (HRQoL) impairments, defined as patient-reported problems within the different dimensions of the three-level EQ-5D (EQ-5D-3L), before and after treatment for active systemic lupus erythematosus (SLE). Patients and methods We conducted a post-hoc analysis of data from two phase III clinical trials of belimumab in SLE, i.e., BLISS-52 ( n = 865) and BLISS-76 ( n = 819). Underweight was defined as BMI <18.5 kg/m 2 , normal weight as BMI ≥18.5 but <25 kg/m 2 , pre-obesity as BMI ≥25 but <30 kg/m 2 , and obesity as BMI ≥30 kg/m 2 . We investigated associations between BMI groups and problems (level 2 or 3) within each one of the five EQ-5D dimensions before treatment initiation and at week 52, using logistic regression analysis adjusting for age, ethnicity, disease activity, and glucocorticoid dose, and for the post-treatment analysis also for belimumab treatment and baseline EQ-5D-3L responses. Results Of 1,684 patients included, 73 (4%) were classified as underweight, 850 (50%) as normal weight, 438 (26%) as pre-obese, and 323 (19%) as obese. At baseline, obesity was associated with mild to severe problems in all EQ-5D dimensions ( p < 0.05 for all), yielding the strongest association with problems in mobility (adjusted odds ratio, aOR: 2.1; 95% confidence interval, CI: 1.6–2.8; p < 0.001). Pre-obesity was also associated with problems in mobility (aOR: 1.4; 95% CI: 1.1–1.8; p = 0.005). Post-intervention, obesity was associated with problems in mobility and pain/discomfort, and pre-obesity with problems in mobility and self-care ( p < 0.05 for all). Conclusion Our study adds to the evidence that high BMI negatively affects SLE patients’ HRQoL, with obesity being associated with pain and impaired mobility despite therapy.