Severe weight loss during the early rheumatoid arthritis (RA) period was associated with increased subsequent mortality risk for women with and without RA, according to a recent study. These results extend prior observations by including non-RA comparators and finding no protective association between weight gain and mortality, arguing against an RA-specific obesity paradox for mortality. Researchers identified incident RA during the Nurses’ Health Study (1976-2016) and created a comparison cohort, matching each RA case with up to 10 non-RA comparators by age and year of RA diagnosis (index date). They found:

• Among 121,701 women, 902 developed incident RA, matched to 7,884 non-RA comparators.
• There were 371 (41.1%) deaths in the RA cohort during mean 17.0-year follow-up after the early RA period and 2,303 (29.2%) deaths among comparators during mean 18.4-year follow-up.
• Early RA period (peri-RA) weight loss >30 pounds had a hazard ratio (HR) of 2.78 for mortality compared to stable weight; the comparison cohort had similar results (HR 2.16).
• Weight gain >30 pounds had no association with mortality among RA (HR 1.45) or comparators (HR 1.19).