Hannan agrees, and adds, “Keep taking the medications because they are your friends if you have early RA. They help you get better. But because you are feeling better you are actually going to regain weight you lost before.” She says a next step could be an intervention study of how patients can regain muscle mass instead of fat.

Gout prevalence and obesity

It’s well documented that obese people have a greater risk of having gout than those who aren’t obese. A new study quantifies that risk using information on more than 28,000 people from the National Center for Health Statistics (a division of the Centers for Disease Control and Prevention). The researchers found that – in an average American who is 5 feet 9 inches tall – for each 1-unit increase in BMI (approximately 6.8 pounds) the risk of gout goes up an additional 5 percent.

“The increased risk doesn’t just begin as you walk through the door of obesity, or step on the scale and find a weight that exceeds the obesity cutoff,” explains study author Allan Gelber, MD, an associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore. “Even at ‘overweight’ levels, there’s a higher risk than those of normal weight.”

In fact, the researchers found those who are overweight (with BMI between 25 and 29.9) have a 50 percent greater risk of gout compared to those of normal weight (with BMI less than 25). That risk is doubled at the first level of obesity (BMI between 30 and 34.9) and three times higher at the second level of obesity (BMI of 35 or more). The elevated risk was seen in men and women as well as across racial/ethnic categories.

What’s more, the researchers say, the risk of gout remained elevated even when uric acid levels were taken into account, suggesting that high uric acid levels are not the only cause of the higher risk.

Dr. Gelber says this is an important reminder that extra pounds can increase your likelihood not just of getting diabetes and heart problems, but also having to deal with this painful condition. “Americans know that excess weight has an adverse health impact, but it also has an adverse impact in the determination of gout,” he says.

Psoriatic arthritis and prediction of minimal disease activity 

This study looked at patients with psoriatic arthritis who started treatment with a tumor necrosis factor blocker (anti-TNF), a class of biologic that includes adalimumab (Humira), infliximab (Remicade) and etanercept (Enbrel). At the 12-month follow-up, about a third of the patients achieved minimal disease activity and stayed stable. Those who were obese (with a BMI greater than 30) were almost five times more likely not to achieve minimal disease activity than those of normal weight. Among those who did reach minimal disease activity in 12 months, those who were not obese were twice as likely to have maintained their status at the 24-month follow-up.

“Whether at 12 months or 24 months, it remains true. It’s at least a doubling of risk or protection. If you are obese, you have at least a doubled risk of having your disease flare up, and if you are of normal weight, you are at least two-fold more likely to maintain your minimal disease activity,” Hannan explains. “So, again, obesity has a negative impact across time on whether people’s psoriatic arthritis becomes active.”

Obesity’s link to the efficacy of anti-TNFs

This Italian study found that obese patients with longstanding RA who are put on anti-TNF therapies are less likely to achieve remission than their lighter-weight counterparts.

Hannan says that the next steps are to understand why and figure out which patients to focus on in order to make their lives better and their disease less severe. “We know people can lose weight and affect muscle mass at any age,” she says. “It’s not easy, but we know they can do it. So we know we can have a positive impact on obesity.”