Talk Over RA: Understanding Obesity and Remission with Rheumatoid Arthritis
Dr. Derin Karacabeyli is a rheumatology resident at the University of British Columbia. His undergraduate studies were in kinesiology at UBC, where he finished Head of Class in his first, second, and third years, and was awarded three Premier Undergraduate Scholarships and the distinction of Wesbrook Scholar. He developed an interest in obesity, which he continued to pursue through his Medical Doctorate and Internal Medicine Residency at UBC.
Under the supervision of UBC and Arthritis Research Canada scientists, Drs. Diane Lacaille and Juan Antonio Avina-Zubieta, Derin is studying the effects of treating metabolic comorbidities like obesity and type 2 diabetes on patients with immune-mediated inflammatory diseases. Upon completion of his rheumatology residency, he plans to pursue a PhD, focussing on pharmacoepidemiology and models of care. His goal is to establish an interdisciplinary metabolic-rheumatology clinic in order to better characterize and manage the unique needs of patients with excess adiposity and inflammatory arthritis.
I first met Derin at the 2019 Canadian Rheumatology Association conference held in Victoria BC Canada. I found his work interesting and that he is part of Arthritis Research Canada. As a member of their patient advisory board, I was able to see his presentations and connect with him at EULAR 23 in Milan and ACR 23 in San Diego. After listening to him speak a few times I knew he would be someone to interview.
I wanted to touch base on obesity with RA for the Talk Over RA campaign as I have noticed it come up often as a comorbidity that can halt someone from remission with RA and often results in poorer outcomes.
Obesity is however a touchy subject for a lot of people going through it. My own weight has fluctuated from the ups and downs living with rheumatoid arthritis and in my medication journey. Through proper education, the help of our integrated care team and self management, something can be done about obesity.
This interview is aimed at understanding the impact obesity can have on rheumatoid arthritis.
How does obesity affect rheumatoid arthritis symptoms and progression? Can obesity contribute to joint damage in rheumatoid arthritis? Can someone who is obese reach remission with rheumatoid arthritis?
In people with rheumatoid arthritis, obesity increases the risk of having more active disease, leading to more chronic pain and disability. Further, obesity appears to reduce a person’s chances of responding to common medications used in rheumatoid arthritis, particularly TNF inhibitors. Interestingly though, following X-rays over time, studies have found that patients with obesity are less likely to have progressive joint damage. To summarize this, patients with obesity and rheumatoid arthritis have more severe symptoms, but do not get more joint damage. While rheumatoid arthritis remission is harder to achieve for people with obesity, it can certainly still be reached!
How can lifestyle modifications, such as exercise and physical activity, impact both obesity and rheumatoid arthritis? What strategies can be adopted to maintain a healthy weight while managing rheumatoid arthritis?
There are many lifestyle measures that can be very helpful for both obesity and rheumatoid arthritis. Regular physical activity, healthy nutrition, and tools to manage psychosocial stressors (like mindfulness meditation and cognitive behavioural therapy) are a few examples that I often recommend for patients to explore. For starters, regular physical activity and making healthy food (and drink) choices can help with weight loss. Putting together the data from lots of studies, we typically see about 2-3kg of weight loss with diet or exercise. Some find this surprising to hear because it’s less than what many people hope for, but I want to highlight a few important points. First, exercise and healthy nutrition have many benefits beyond weight loss (for example, better blood pressure, blood sugar, and cholesterol control, leading to lower risk of heart attacks and strokes). Second, small amounts of weight loss, like 5%, can still make meaningful differences in a person’s overall health. Finally, these numbers are just averages! Some lose more, some lose less, and that’s okay. What’s more important than weight loss is making healthy choices daily that benefit your physical and mental wellbeing so you can live a long and happy life.
I encourage regular physical activity and healthy nutrition in all patients with rheumatoid arthritis, regardless of whether they have obesity. Exercise improves quality of life, pain, sleep, and function for people living with rheumatoid arthritis. I typically recommend a Mediterranean-style diet with lots of plant-based whole foods because it reduces one’s risk of serious events like cardiovascular death, heart attack, and stroke, and research suggests it improves pain in rheumatoid arthritis as well.
In terms of strategies to maintain a healthy weight while managing rheumatoid arthritis, I suggest getting connected! People living with rheumatoid arthritis face unique challenges, and maintaining a healthy weight is hard enough as is with no other medical conditions. My advice is to not do it alone and to explore the tools around you, whether that be local professionals with expertise and experience (kinesiologists, physiotherapists, dieticians), individuals with shared experiences (e.g., patient groups), classes, or resources. We are lucky in British Columbia to have many excellent resources, including the HealthLink BC “8-1-1” phone line (https://www.healthlinkbc.ca/more/contact-us/8-1-1), where you can speak with a registered dietitian or qualified exercise professional for free from 9am-5pm Monday-Friday. There is also oasis.vch.ca, where you can find online or in-person classes on a host of topics like arthritis & exercise, pain management, meditation, and much more. The OASIS website is designed for osteoarthritis, but patients with rheumatoid arthritis have found it very helpful as well. Finally, if you have rheumatoid arthritis and live in Vancouver, you can ask your rheumatologist for a referral to the Mary Pack Arthritis Program for tailored physiotherapy and/or occupational therapy. If you don’t live in Vancouver, I’d still suggest talking to your rheumatologist about what services might be available to you locally. The Mary Pack Arthritis Program has also made a host of helpful information on arthritis self-management available here: http://mpap.vch.ca/.
What are the potential risks and benefits of weight loss surgery for individuals with rheumatoid arthritis?
Two studies have shown that after bariatric surgery, rheumatoid arthritis disease activity improves. These results are promising, but more research is needed to fully understand risks and benefits. There are many types of bariatric surgery, and degrees of weight loss as well as potential harms vary based on a host of factors. The Richmond Metabolic & Bariatric Surgery team has put together helpful resources, which can be found here: https://www.vch.ca/en/service/metabolic-bariatric-surgery#faq–52461.
Are there any additional complications or comorbidities associated with obesity and rheumatoid arthritis that one should be aware of?
Higher rates of osteoarthritis, depression, and fibromyalgia are seen in patients with obesity, and all of these can also be seen in rheumatoid arthritis. These can all impact quality of life and function, so I once again want to highlight the importance of daily practices like partaking in physical activity, consuming healthy foods, and managing psychosocial stressors (for example, trying mindfulness meditation) to optimize one’s physical and mental wellbeing. Obesity and rheumatoid arthritis also both increase the risk of serious cardiovascular events like heart attack and stroke, but fortunately, this risk is reduced with regular exercise, healthy diet, weight loss, and management of the rheumatoid arthritis.
Is weight loss or weight management important for reducing symptoms of rheumatoid arthritis? What other care providers can help patients achieve a healthy weight?
In patients with obesity, weight loss can help improve symptoms. Qualified exercise professionals (like kinesiologists and physiotherapists) and registered dieticians are excellent resources to help empower people to reach their goals.
Can you tell us about your research around obesity and rheumatoid arthritis? Why is this important for patients to know? Please link to any abstracts published.
Happily! I’m interested in how the treatment of metabolic diseases like obesity and diabetes might impact patients with autoimmune rheumatic diseases, including rheumatoid arthritis. I’ve led three projects so far and a few others are in the works. First, we performed a national survey of Canadian rheumatology health care providers, exploring their views and practices on obesity and smoking cessation management in rheumatoid arthritis. We found that common barriers to addressing weight were lack of time, training, access to expertise, and knowledge of available programs (https://pubmed.ncbi.nlm.nih.gov/33517485/). We are now creating resources to address these gaps so providers can more effectively address obesity with their patients. Second, I summarized the research to date on how a class of diabetes drugs called glucagon-like peptide-1 receptor agonists (which have been found to facilitate weight loss) affects patients with rheumatoid arthritis or psoriasis (https://pubmed.ncbi.nlm.nih.gov/36870080/). This drug class has also been shown to reduce the risk of death and stroke in the general population with diabetes, but it hasn’t been studied in people who have both diabetes and autoimmune diseases. For this reason, our third project aimed to see if this cardiovascular benefit was also present in patients with autoimmune rheumatic diseases, including rheumatoid arthritis. We found that it was, and that patients with autoimmune rheumatic diseases benefitted just as much as those without (https://ard.bmj.com/content/82/Suppl_1/16.2.abstract).
Download The Talk Over RA Discussion Guide
TalkOverRA is a platform that aims to empower people living with rheumatoid arthritis to advocate for themselves and their healthcare needs. It provides resources, community support, and tools to help individuals communicate effectively with their doctors and healthcare providers. The campaign emphasizes the importance of self-advocacy and provides tips for assertive communication and asking the right questions.
2023 Talk Over RA Content
- Patient Leaders Talk Over RA Video
- Canada – Dr. Cheryl Barnabe
- United States – Dr. Jen Barton
- Brazil – Dr. André Luiz Luquini Pereira
- Talk Over RA 2020 – 2023 Recap
- Talk Over RA – Important Questions To Ask Your Rheumatoid Arthritis Care Team
- Talk Over RA – Understanding Obesity and Remission with Rheumatoid Arthritis
- Talk Over RA – What I Learned About Remission and Rheumatoid Arthritis At The 2023 American College of Rheumatology Conference
Be Sure To Follow The Other Talk Over RA Advocates!
- Lene Andersen –@theseatedview
- Julia McNally –@the.ra.yogi
- Michael Kuluva – @michaelkuluva
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