<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2413-4341</journal-id>
<journal-title><![CDATA[Revista Paraguaya de Reumatología]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. parag. reumatol.]]></abbrev-journal-title>
<issn>2413-4341</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Reumatología]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2413-43412018000200031</article-id>
<article-id pub-id-type="doi">10.18004/rpr/2018.04.02.31-38</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Impacto de la obesidad y su relación con la actividad de la enfermedad en pacientes con Artritis Reumatoide]]></article-title>
<article-title xml:lang="en"><![CDATA[Impact and relationship of obesity with diseaseactivity of patients with rheumatoid arthritis]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Paats]]></surname>
<given-names><![CDATA[Astrid]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Román]]></surname>
<given-names><![CDATA[Lourdes]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Acosta]]></surname>
<given-names><![CDATA[Rodrigo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cabrera-Villalba]]></surname>
<given-names><![CDATA[Sonia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Asunción Facultad de Ciencias Médicas Hospital de Clínicas, Departamento de Reumatología]]></institution>
<addr-line><![CDATA[San Lorenzo ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2018</year>
</pub-date>
<volume>4</volume>
<numero>2</numero>
<fpage>31</fpage>
<lpage>38</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2413-43412018000200031&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2413-43412018000200031&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2413-43412018000200031&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN Introducción: La artritis reumatoide (AR) es una enfermedad inflamatoria crónica, caracterizada por la inflamación sinovial poliarticular, con una prevalencia mundial aproximada del 1%. A pesar de importantes mejoras terapéuticas del control inflamatorio de pacientes con AR, existe un grupo de pacientes que no responden al tratamiento y tienen un mayor riesgo de deterioro funcional, discapacidad laboral y disminución de la calidad de vida. La obesidad o el sobrepeso se han asociado con peores resultados, como una menor probabilidad de lograr un buen control inflamatorio, del dolor y con un mayor deterioro funcional en pacientes con AR. Objetivos: Establecer las características clínico-epidemiológicas de pacientes con artritis reumatoide con obesidad, sobrepeso y peso normal y describir su relación con la actividad de la enfermedad. Materiales y métodos: Estudio descriptivo, analítico, de corte trasversal. Se revisaron las historias clínicas de los pacientes con el diagnóstico de artritis reumatoide, según los criterios ACR 1987 al ACR 2010, a partir del año 2010 al 2018 en seguimiento regular en el departamento de Reumatología del Hospital de Clínicas, de la Universidad Nacional de Asunción. Se completó un cuestionario con variables epidemiológicas (i.e. sexo, edad, procedencia), clínicas (i.e., tiempo de evolución de la enfermedad, actividad de enfermedad (DAS 28), antecedentes patológicos personales, comorbilidades, laboratoriales (reactantes de fase aguda, factor reumatoide, ACPA) y radiográficas. Las variables cualitativas se expresan en frecuencias y porcentajes y las cuantitativas en medias con el desvío están- dar. Se utilizó chi cuadrado para variables cualitativas y la T-student para las cuantitativas. El análisis estadístico se realizó con el programa estadístico SPSS vs.23.0. Se consideró una significancia estadística una p&lt;0.05. Resultados: Se incluyeron un total de 165 pacientes con el diagnóstico de artritis reumatoide, de éstos el 82,4% (135/165) correspondían al sexo femenino. El promedio de duración de la enfermedad fue de 8,5 ± 8,4 años. El 75,9% (120/165) presentaba FR positivo y el 86,6% (97/112) ACPA positivo. El 44,6% (54/65) de los pacientes tenía erosiones en las radiografías. La media del DAS 28 fue de 3,55 ± 1,31. El 59,4% de los pacientes estaba en tratamiento concomitante con prednisona, con una dosis media de 7,63 ± 4,9 mg/d. El 40% (66/165) presentaba obesidad y el 35,8% (59/165) sobrepeso, el promedio de IMC fue de 28,7 ± 5,38. Al comparar las distintas variables entre los pacientes con obesidad y los no obesos, encontramos que los obesos requieren un mayor número de FAMEs (Obesidad: 1,85 ± 0,685 vs No Obesidad: 1,61 ± 0,737 p:0,035), con mayor frecuencia estaban en tratamiento con prednisona (Obesos: 69% vs No Obesos: 52% p:0,028). Los pacientes no obesos alcanzaron la remisión de la enfermedad medida por SDAI en mayor proporción (Obesos: 1,5% vs No Obesos: 15% p: 0,009). Conclusión: Existe una elevada frecuencia de obesidad y sobrepeso en nuestra población de pacientes con AR. Los pacientes obesos precisaban un mayor número de FAMEs, y de prednisona, y en menor porcentaje lograban la remisión de la enfermedad medida por SDAI, por lo que es fundamental el control riguroso del peso, incentivando la pérdida del mismo, educando a nuestros pacientes, a fin de mejorar la severidad y el pronóstico de la enfermedad e indirectamente la calidad de vida de nuestros pacientes.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by polyarticular synovial inflammation, with a worldwide prevalence of approximately 1%. Despite significant therapeutic improvements in controlling inflammation of patients with RA, there is a group of patients who don&#8217;t respond to treatment, and have greater risk of functional impairment, work disability and decreased quality of life. Obesity and being over- weight have been associated with worse outcomes, such as a lower probability of achieving satisfactory inflammatory and pain control and greater functional impairment in patients with RA. Objective: To establish the clinical-epidemiological characteristics of RA patients with obesity, overweight and normal weight and describe the relationship with disease activity. materials and methods: descriptive, analytical, cross-sectional study. We reviewed medical records of patients who had been diagnosed with RA (according to ACR 1987 and ACR 2010 criteria) from 2010 to 2018, in regular follow-up in the Rheumatology department of Hospital de Clínicas, National University of Asunción. A questionnaire was completed with epidemiological (ie sex, age, origin) and clinical variables (ie, disease duration, disease activity (DAS 28), patient medical history, comorbidities, laboratory (acute phase reactants, rheumatoid factor, ACPA) and radiographic data (erosions). Qualitative variables are ex- pressed in frequencies and percentages and quantitative variables are averaged with standard deviation. Chi Square was used for qualitative variables and T-student for quantitative ones. The statistical analysis was carried out with the statistical program SPSS V.23.0. A p of &lt;0.05 was considered statistically significant. Results: A total of 165 patients with a diagnosis of RA were included, of which 82.4% (135/165) were female. The average duration of the disease was 8.5 ± 8.4 years. Approximately 76% (120/165) had a positive RF and 86.6% (97/112) were ACPA positive. Fifty four (44.6%) patients had erosions on X-Rays. The mean DAS 28 score was 3.55 ± 1.31. Almost 60% were on concomitant treatment with prednisone, with an average dose of 7.63 ± 4.9 mg/d. Forty percent (66/165) had obesity and 35.8% (59/165) were overweight. The average BMI was 28.7 ± 5.38. When comparing the different variables between obese and non-obese patients, we found that obese patients require a greater number of DMARDs (Obesity: 1.85 ± 0.685 vs No Obesity: 1.61 ± 0.737 p:0.035) and they were under treatment with prednisone more frequently (Obese: 69% vs. No Obese: 52% p: 0.028). Non-obese patients achieved remission measured by SDAI in a greater proportion (Obese: 1.5% vs Non-Obese: 15% p:0.009). Conclusion: There is a high frequency of obesity and overweight in our population of patients with RA. Obese patients needed a greater number of DMARDs and prednisone, and achieved remission measured by SDAI in a lower percentage. It is essential to rigorously control the weight by encouraging loss of excess weight and educating patients, in order to improve the severity and prognosis of the disease and indirectly, the quality of life of our patients.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Obesidad]]></kwd>
<kwd lng="es"><![CDATA[Artritis Reumatoide]]></kwd>
<kwd lng="en"><![CDATA[Obesity]]></kwd>
<kwd lng="en"><![CDATA[Rheumatoid Arthritis]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tobón]]></surname>
<given-names><![CDATA[GJ]]></given-names>
</name>
<name>
<surname><![CDATA[Youinou]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Saraux]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The environment, geo-epidemiology, and autoimmune disease: Rheumatoid arthritis]]></article-title>
<source><![CDATA[J Autoimmun]]></source>
<year>2010</year>
<volume>35</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>10-4</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Katchamart]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Johnson]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Lin]]></surname>
<given-names><![CDATA[HJL]]></given-names>
</name>
<name>
<surname><![CDATA[Phumethum]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Salliot]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Bombardier]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Predictors for remission in rheumatoid arthritis patients: A systematic review]]></article-title>
<source><![CDATA[Arthritis Care Res]]></source>
<year>2010</year>
<volume>62</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>1128-43</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Conaghan]]></surname>
<given-names><![CDATA[PG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Predicting outcomes in rheumatoid arthritis]]></article-title>
<source><![CDATA[Clin Rheumatol]]></source>
<year>2011</year>
<volume>30</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>S41-7</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Smolen]]></surname>
<given-names><![CDATA[JS]]></given-names>
</name>
<name>
<surname><![CDATA[Aletaha]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Barton]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Burmester]]></surname>
<given-names><![CDATA[GR]]></given-names>
</name>
<name>
<surname><![CDATA[Emery]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Firestein]]></surname>
<given-names><![CDATA[GS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Rheumatoid arthritis]]></article-title>
<source><![CDATA[Nat Rev Dis Primer]]></source>
<year>2018</year>
<volume>4</volume>
<page-range>18001</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Elkan]]></surname>
<given-names><![CDATA[AC]]></given-names>
</name>
<name>
<surname><![CDATA[Engvall]]></surname>
<given-names><![CDATA[IL]]></given-names>
</name>
<name>
<surname><![CDATA[Cederholm]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Hafström]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Rheumatoid cachexia, central obesity and malnutrition in patients with low-active rheumatoid arthritis: feasibility of anthropometry, Mini Nutritional Assessment and body composition techniques]]></article-title>
<source><![CDATA[Eur J Nutr]]></source>
<year>2009</year>
<volume>48</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>315-22</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="">
<collab>WHO</collab>
<source><![CDATA[| By category | Prevalence of overweight among adults, BMi &#8805; 25, age-standardized - Estimates by WHO Region]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cañete]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Fretes]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[vG]]></surname>
<given-names><![CDATA[Sequera]]></given-names>
</name>
<name>
<surname><![CDATA[Turnes]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Santacruz]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Paiva]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Epidemiología de la obesidad en el Paraguay]]></article-title>
<source><![CDATA[An Fac Cienc Médicas Asunción]]></source>
<year>2016</year>
<volume>49</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>17-26</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kerekes]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Nurmohamed]]></surname>
<given-names><![CDATA[MT]]></given-names>
</name>
<name>
<surname><![CDATA[González-Gay]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Seres]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Paragh]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Kardos]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Rheumatoid arthritis and metabolic syndrome]]></article-title>
<source><![CDATA[Nat Rev Rheumatol]]></source>
<year>2014</year>
<volume>10</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>691-6</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Michaud]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Wolfe]]></surname>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Comorbidities in rheumatoid arthritis. - PubMed - NCBi]]></article-title>
<source><![CDATA[]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Radner]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Yoshida]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Frits]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Iannaccone]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Shadick]]></surname>
<given-names><![CDATA[NA]]></given-names>
</name>
<name>
<surname><![CDATA[Weinblatt]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The impact of multimorbidity status on treatment response in rheumatoid arthritis patients initiating disease modifying anti- rheumatic drugs]]></article-title>
<source><![CDATA[Rheumatol Oxf Engl]]></source>
<year>2015</year>
<volume>54</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>2076-84</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Solomon]]></surname>
<given-names><![CDATA[DH]]></given-names>
</name>
<name>
<surname><![CDATA[Karlson]]></surname>
<given-names><![CDATA[EW]]></given-names>
</name>
<name>
<surname><![CDATA[Rimm]]></surname>
<given-names><![CDATA[EB]]></given-names>
</name>
<name>
<surname><![CDATA[Cannuscio]]></surname>
<given-names><![CDATA[CC]]></given-names>
</name>
<name>
<surname><![CDATA[Mandl]]></surname>
<given-names><![CDATA[LA]]></given-names>
</name>
<name>
<surname><![CDATA[Manson]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis]]></article-title>
<source><![CDATA[Circulation]]></source>
<year>2003</year>
<volume>107</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>1303-7</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wolfe]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Freundlich]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Straus]]></surname>
<given-names><![CDATA[WL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis]]></article-title>
<source><![CDATA[J Rheumatol]]></source>
<year>2003</year>
<volume>30</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>36-40</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Magda]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Rheumatoid arthritis vs. diabetes mellitus as risk factors for cardiovascular disease: the CARRE study]]></article-title>
<source><![CDATA[Mædica]]></source>
<year>2010</year>
<volume>5</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>147</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sattar]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Mcinnes]]></surname>
<given-names><![CDATA[IB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Vascular comorbidity in rheumatoid arthritis: potential mechanisms and solutions]]></article-title>
<source><![CDATA[Curr Opin Rheumatol.]]></source>
<year>2005</year>
<volume>17</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>286-92</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Turesson]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Matteson]]></surname>
<given-names><![CDATA[EL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cardiovascular risk factors, fitness and physical activity in rheumatic diseases]]></article-title>
<source><![CDATA[Curr Opin Rheumatol.]]></source>
<year>2007</year>
<volume>19</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>190-6</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Davis]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Maradit Kremers]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Crowson]]></surname>
<given-names><![CDATA[CS]]></given-names>
</name>
<name>
<surname><![CDATA[Nicola]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
<name>
<surname><![CDATA[Kv]]></surname>
<given-names><![CDATA[Ballman]]></given-names>
</name>
<name>
<surname><![CDATA[Therneau]]></surname>
<given-names><![CDATA[TM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Glucocorticoids and cardiovascular events in rheumatoid arthritis: a population-based cohort study]]></article-title>
<source><![CDATA[Arthritis Rheum]]></source>
<year>2007</year>
<volume>56</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>820-30</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ajeganova]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Andersson]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
<name>
<surname><![CDATA[Hafström]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[BARFOT Study Group. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: a long-term followup from disease onset]]></article-title>
<source><![CDATA[Arthritis Care Res]]></source>
<year>2013</year>
<volume>65</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>78-87</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Westhoff]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Rau]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Zink]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Radiographic joint damage in early rheumatoid arthritis is highly dependent on body mass index]]></article-title>
<source><![CDATA[Arthritis Rheum]]></source>
<year>2007</year>
<volume>56</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>3575-82</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="">
<collab>PubMed - NCBI</collab>
<source><![CDATA[The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aletaha]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative]]></article-title>
<source><![CDATA[PubMed - NCBi]]></source>
<year>2010</year>
</nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Prevoo]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
<name>
<surname><![CDATA[van &#8217;t Hof]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Kuper]]></surname>
<given-names><![CDATA[HH]]></given-names>
</name>
<name>
<surname><![CDATA[van Leeuwen]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[van de Putte]]></surname>
<given-names><![CDATA[LB]]></given-names>
</name>
<name>
<surname><![CDATA[van Riel]]></surname>
<given-names><![CDATA[PL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a pros- pective longitudinal study of patients with rheumatoid arthritis]]></article-title>
<source><![CDATA[Arthritis Rheum]]></source>
<year>1995</year>
<volume>38</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>44-8</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aletaha]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Nell]]></surname>
<given-names><![CDATA[VPK]]></given-names>
</name>
<name>
<surname><![CDATA[Stamm]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Uffmann]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Pflugbeil]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Machold]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score]]></article-title>
<source><![CDATA[Arthritis Res Ther]]></source>
<year>2005</year>
<volume>7</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>R796-806</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Smolen]]></surname>
<given-names><![CDATA[JS]]></given-names>
</name>
<name>
<surname><![CDATA[Breedveld]]></surname>
<given-names><![CDATA[FC]]></given-names>
</name>
<name>
<surname><![CDATA[Schiff]]></surname>
<given-names><![CDATA[MH]]></given-names>
</name>
<name>
<surname><![CDATA[Kalden]]></surname>
<given-names><![CDATA[JR]]></given-names>
</name>
<name>
<surname><![CDATA[Emery]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Eberl]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A simplified disease activity index for rheumatoid arthritis for use in clinical practice]]></article-title>
<source><![CDATA[Rheumatol Oxf Engl]]></source>
<year>2003</year>
<volume>42</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>244-57</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="">
<source><![CDATA[Obesity and overweight]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dougados]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Soubrier]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Antunez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Balint]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Balsa]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Buch]]></surname>
<given-names><![CDATA[MH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA)]]></article-title>
<source><![CDATA[Ann Rheum Dis]]></source>
<year>2014</year>
<volume>73</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>62-8</page-range></nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gómez]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Conde]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Scotece]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Gómez-Reino]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Lago]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Gualillo]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[What&#8217;s new in our understanding of the role of adipokines in rheu- maticdiseases?]]></article-title>
<source><![CDATA[Nat Rev Rheumatol]]></source>
<year>2011</year>
<volume>7</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>528-36</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Versini]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Jeandel]]></surname>
<given-names><![CDATA[PY]]></given-names>
</name>
<name>
<surname><![CDATA[Rosenthal]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Shoenfeld]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Obesity in auto- immune diseases: not a passive bystander]]></article-title>
<source><![CDATA[Autoimmun Rev]]></source>
<year>2014</year>
<volume>13</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>981-1000</page-range></nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Baker]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
<name>
<surname><![CDATA[George]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Baker]]></surname>
<given-names><![CDATA[DG]]></given-names>
</name>
<name>
<surname><![CDATA[Toedter]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[von Feldt]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Leonard]]></surname>
<given-names><![CDATA[MB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Associations between body mass, radiographic joint damage, adipokines and risk factors for bone loss in rheumatoid arthritis]]></article-title>
<source><![CDATA[Rheumatol Oxf Engl]]></source>
<year>2007</year>
<volume>50</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>2100-7</page-range></nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kaufmann]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[v]]></surname>
<given-names><![CDATA[Kielstein]]></given-names>
</name>
<name>
<surname><![CDATA[Kilian]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Stein]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Hein]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Relation between body mass index and radiological progression in patients with rheu- matoid arthritis]]></article-title>
<source><![CDATA[J Rheumatol]]></source>
<year>2003</year>
<volume>30</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>2350-5</page-range></nlm-citation>
</ref>
<ref id="B30">
<label>30</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Heimans]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[van den Broek]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Le Cessie]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Siegerink]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Riyazi]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Han]]></surname>
<given-names><![CDATA[KH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Association of high body mass index with decreased treatment response to combination therapy in recent-onset rheuma toidarthritispatients]]></article-title>
<source><![CDATA[Arthritis Care Res]]></source>
<year>2013</year>
<volume>65</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>1235-42</page-range></nlm-citation>
</ref>
<ref id="B31">
<label>31</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[George]]></surname>
<given-names><![CDATA[MD]]></given-names>
</name>
<name>
<surname><![CDATA[Baker]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Obesity Epidemic and Consequences for Rheumatoid Arthritis Care]]></article-title>
<source><![CDATA[Curr Rheumatol Rep]]></source>
<year>2016</year>
<volume>18</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>6</page-range></nlm-citation>
</ref>
<ref id="B32">
<label>32</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ottaviani]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Gardette]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Tubach]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Roy]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Palazzo]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Gill]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Body mass index and response to infliximab in rheumatoid arthritis]]></article-title>
<source><![CDATA[Clin Exp Rheumatol]]></source>
<year>2015</year>
<volume>33</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>478-83</page-range></nlm-citation>
</ref>
<ref id="B33">
<label>33</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sandberg]]></surname>
<given-names><![CDATA[MEC]]></given-names>
</name>
<name>
<surname><![CDATA[Bengtsson]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Källberg]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Wesley]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Klareskog]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Alfredsson]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Overweight decreases the chance of achieving good response and low disease activity in early rheumatoid arthritis]]></article-title>
<source><![CDATA[Ann Rheum Dis]]></source>
<year>2014</year>
<volume>73</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>2029-33</page-range></nlm-citation>
</ref>
<ref id="B34">
<label>34</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Klaasen]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Wijbrandts]]></surname>
<given-names><![CDATA[CA]]></given-names>
</name>
<name>
<surname><![CDATA[Gerlag]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Tak]]></surname>
<given-names><![CDATA[PP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Body mass index and clinical response to infliximab in rheumatoid arthritis]]></article-title>
<source><![CDATA[Arthritis Rheum]]></source>
<year>2011</year>
<volume>63</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>359-64</page-range></nlm-citation>
</ref>
<ref id="B35">
<label>35</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Caplan]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Davis]]></surname>
<given-names><![CDATA[LA]]></given-names>
</name>
<name>
<surname><![CDATA[Bright]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Kerr]]></surname>
<given-names><![CDATA[GS]]></given-names>
</name>
<name>
<surname><![CDATA[Lazaro]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Khan]]></surname>
<given-names><![CDATA[NA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Body mass index and the rheumatoid arthritis swollen joint count: an observational study]]></article-title>
<source><![CDATA[Arthritis Care Res]]></source>
<year>2013</year>
<volume>65</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>101-6</page-range></nlm-citation>
</ref>
<ref id="B36">
<label>36</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mirpourian]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Salesi]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Abdolahi]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Farajzadegan]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Karimzadeh]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The association of body mass index with disease activity and clinical response to combination therapy in patients with rheumatoid arthritis]]></article-title>
<source><![CDATA[J Res Med Sci Off J isfahan univ Med Sci]]></source>
<year>2014</year>
<volume>19</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>509-14</page-range></nlm-citation>
</ref>
<ref id="B37">
<label>37</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Schulman]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Bartlett]]></surname>
<given-names><![CDATA[SJ]]></given-names>
</name>
<name>
<surname><![CDATA[Schieir]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Andersen]]></surname>
<given-names><![CDATA[KM]]></given-names>
</name>
<name>
<surname><![CDATA[Boire]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Pope]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Overweight, Obesity, and the Likelihood of Achieving Sustained Remission in Early Rheumatoid Arthritis: Results From a Multicenter Prospective Cohort Study]]></article-title>
<source><![CDATA[Arthritis Care Res]]></source>
<year>2018</year>
<volume>70</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>1185-91</page-range></nlm-citation>
</ref>
<ref id="B38">
<label>38</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kreps]]></surname>
<given-names><![CDATA[DJ]]></given-names>
</name>
<name>
<surname><![CDATA[Halperin]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Desai]]></surname>
<given-names><![CDATA[SP]]></given-names>
</name>
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[ZZ]]></given-names>
</name>
<name>
<surname><![CDATA[Losina]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Olson]]></surname>
<given-names><![CDATA[AT]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Association of weight loss with improved disease activity in patients with rheumatoid arthritis: A retrospective analysis using electronic medical record data]]></article-title>
<source><![CDATA[Int JClin Rheumatol]]></source>
<year>2018</year>
<volume>13</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>1-10</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
