Abdominal obesity, gender and the risk of rheumatoid arthritis - a nested case-control study

The risk of development of rheumatoid arthritis (RA) could be affected by immune activation in obesity. Our objective was to evaluate the association between obesity in general, and abdominal obesity, and the risk for subsequent development of RA.

In two large population-based, prospective cohorts, 557 cases (mean age at RA symptom onset 58, SD 10 years, 68% women) who subsequently developed RA and 1671 matched controls were identified. From a health examination antedating symptom onset (median 5.5 years), collected data on body mass index (BMI; kg/m²), smoking habits, and educational level was used in conditional logistical regression models. Corresponding regression models were used to analyse the association between waist circumference measurements (cm) and RA development in a subset of the population.

BMI and waist circumference were associated with the risk of RA development, adjusted odds ratio (OR) (95% CI), 1.13 (1.00, 1.28) per 5 kg/m², and 1.02 (1.01, 1.04) per cm, respectively. An association was also observed for obesity (BMI ≥30) OR 1.45 (1.07, 1.95), compared with BMI <25. After stratification for sex the associations were enhanced in men, and attenuated in women. Among men with BMI above normal a 3-5 times increased risk for RA disease development at 50 years of age or earlier was observed. Abdominal obesity with waist circumference >102 cm was associated with a 2-3 times increased risk of RA, but not abdominal obesity (>88 cm) in women.

Obesity or abdominal obesity, respectively, was independently associated with a modest increase of the risk for subsequent development of RA. This appeared to be relevant mainly for early RA disease onset among men.