TY - JOUR
T1 - Obesity, Adipokines, and Chronic and Persistent Pain in Rheumatoid Arthritis
AU - Baker, Joshua F.
AU - Wipfler, Kristin
AU - Olave, Marianna
AU - Pedro, Sofia
AU - Katz, Patricia
AU - Michaud, Kaleb
N1 - Funding Information:
Dr. Baker would like to acknowledge funding through a Veterans Affairs Clinical Science Research & Development Career Merit Award (I01 CX001703) as well as support by from the VA Rehabilitation Research & Development (I21 CX003157; I01 CX003644). The contents of this work do not represent the views of the Department of the Veterans Affairs or the U.S. Government.
Funding Information:
This work was supported by a VA Clinical Science Research & Development Merit Award ( CX001703 ). The authors have no conflicts to disclose.
Publisher Copyright:
© 2023
PY - 2023/10
Y1 - 2023/10
N2 - We aimed to determine whether adipokines are associated with pain and polysymptomatic distress in patients with rheumatoid arthritis (RA) over time in a large patient registry. The cohort study was conducted in a subset of Forward; a patient-based multi-disease, multipurpose rheumatic disease registry with patients enrolled from community-based rheumatology practices across the U.S. Adipokines (adiponectin, leptin, and fibroblast growth factor[FGF]-21) were measured on stored serum as part of a multi-analyte panel. Body mass index (BMI), pain, polysymptomatic distress, and other patient-reported outcomes (PROs) were reported on biannual questionnaires. Linear regression was used to evaluate independent associations between BMI, adipokines, and PROs. Cox proportional hazards models evaluated independent associations between adipokines and clinically meaningful changes in pain over time (change in numerical rating>1.1 [range 0–10], sustained over 1 year). Among 645 patients included in these analyses, there were significant differences in RA characteristics, comorbidity, PROs, and adipokines across obesity categories. Of note, severely obese patients were more likely to experience greater pain, polysymptomatic distress, and fatigue. Patients with higher FGF-21 levels had higher pain and polysymptomatic stress at baseline, were more likely to use opioids, and were more likely to have sustained worsening pain over time [HR (per 1 SD) (95% CI): 1.22 (1.02,1.46) P = .03] independent of BMI. Obesity and elevated levels of FGF-21 are associated with pain and polysymptomatic distress in RA. Elevated FGF-21 levels may help identify those at risk of worsening pain trajectories over time, independent of BMI. Perspective: This study characterizes the relationship between severe obesity and pain and polysymptomatic distress in patients with rheumatoid arthritis and demonstrates that the adipocytokine fibroblast growth factor-21 is independently associated with pain and predicts a worsening trajectory over time. Further mechanistic studies are needed.
AB - We aimed to determine whether adipokines are associated with pain and polysymptomatic distress in patients with rheumatoid arthritis (RA) over time in a large patient registry. The cohort study was conducted in a subset of Forward; a patient-based multi-disease, multipurpose rheumatic disease registry with patients enrolled from community-based rheumatology practices across the U.S. Adipokines (adiponectin, leptin, and fibroblast growth factor[FGF]-21) were measured on stored serum as part of a multi-analyte panel. Body mass index (BMI), pain, polysymptomatic distress, and other patient-reported outcomes (PROs) were reported on biannual questionnaires. Linear regression was used to evaluate independent associations between BMI, adipokines, and PROs. Cox proportional hazards models evaluated independent associations between adipokines and clinically meaningful changes in pain over time (change in numerical rating>1.1 [range 0–10], sustained over 1 year). Among 645 patients included in these analyses, there were significant differences in RA characteristics, comorbidity, PROs, and adipokines across obesity categories. Of note, severely obese patients were more likely to experience greater pain, polysymptomatic distress, and fatigue. Patients with higher FGF-21 levels had higher pain and polysymptomatic stress at baseline, were more likely to use opioids, and were more likely to have sustained worsening pain over time [HR (per 1 SD) (95% CI): 1.22 (1.02,1.46) P = .03] independent of BMI. Obesity and elevated levels of FGF-21 are associated with pain and polysymptomatic distress in RA. Elevated FGF-21 levels may help identify those at risk of worsening pain trajectories over time, independent of BMI. Perspective: This study characterizes the relationship between severe obesity and pain and polysymptomatic distress in patients with rheumatoid arthritis and demonstrates that the adipocytokine fibroblast growth factor-21 is independently associated with pain and predicts a worsening trajectory over time. Further mechanistic studies are needed.
KW - Rheumatoid arthritis
KW - adipokines
KW - obesity
UR - http://www.scopus.com/inward/record.url?scp=85164320159&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85164320159&partnerID=8YFLogxK
U2 - 10.1016/j.jpain.2023.05.008
DO - 10.1016/j.jpain.2023.05.008
M3 - Article
C2 - 37207978
AN - SCOPUS:85164320159
SN - 1526-5900
VL - 24
SP - 1813
EP - 1819
JO - Journal of Pain
JF - Journal of Pain
IS - 10
ER -