Obesity and inflammatory markers

[Elmo333]

Hi all. I’ve just copied a section of text from NRAS site. I worry about this topic. I am very overweight and my inflammatory markers are consistently raised, ESR around 50 and CRP around 30. They do go higher when thing are really bad they are never normal despite MTX and HYX. My consultant takes a lot of notice of my blood results and often comments about active inflammation. I try to convince myself that I do not really have RA very frequently because there are times when my joints are fine but my rheumatologist says he is certain because I’m anti CCP and RF positive. I can’t talk to him about the inflammatory markers thing because he’ll just tell me (again) to go and lose weight, which I don’t seem to be able to do. It’s not really a question, I’m just wondering if anyone has any thoughts...? Thanks

[helixhelix]

I’m afraid that everything I have read supports that view - sorry!

People with a high BMI not only tend to have higher inflammation levels and more active disease, but they respond less well to the drugs, are less likely to achieve remission, and have a greater risk of heart and lung complications. And that’s before the extra weight puts more pressure on the joints.

I lost several stone after diagnosis, so I do realise how near-impossibly hard it is, but loosing weight is nearly as important as your drugs.

[Elmo333 in reply to helixhelix]

Thanks helix. I agree with some of what you have said but I have not read any convincingly credible papers about weight linked to more active disease or less response to medication. I can very well see the point about extra pressure and links to heart but more as an independent variable rather than causation.

You are exceptionally knowledgeable and give great advise but I have noticed before a slight judgement about weight from some of your comments a few times before. I am very aware that losing weight is best for every aspect of health for everyone but when you put on 6 stone in 4 months from mental health medication, it’s not a recommendation I need. I had RA before I was fat!

I do think you are amazingly helpful to lots of people on this forum but maybe just be a bit more aware of commenting on weight as being the most important factor.

Thanks

[Brushwork in reply to Elmo333]

I really don’t believe being over weight causes RA. However, I am very aware and research strongly indicates that being over weight leads to RA being more severe.

It’s not a judgment, it’s a fact.

I had a long conversation with my Rheumatologist about it. Their understanding of the disease and how it works has and is changing with a lot more focus on weight and diet. My Rheumatology dept is associated with a university teaching department and therefore up to date.

It is also a fact that some drugs are prone to increasing ones appetite, and therefore weight gain, making it almost impossible to lose weight.

[charisma in reply to Brushwork]

I was never overweight but got an aggressive type of RA... they just don’t yet have proper answers!

[Brushwork in reply to charisma]

Oh I completely understand that RA is not entirely dependent on weight. But diet and weight are important factors. Especially high fat diets.

[helixhelix in reply to Elmo333]

I’m sorry if it comes across as judgemental, I don’t mean to be as I too struggle with weight control. But many times I feel it is the elephant in the room, and because loosing weight is so hard we try to find other reasons, solutions, approaches rather than mention the weight. As you well know, trying to live well with this disease is not just about going to the doctor and being handed drugs to take, but needs our active participation as self help is so important. Whether that’s a stock of ice packs in the freezer, or going for a walk. And weight is a big aspect of this whether we like it or not.

There are quite a few studies on this, like here

ncbi.nlm.nih.gov/pmc/articl...

[charisma in reply to Elmo333]

Hi Elmo, mental health is a big issue for sure. If you can be active eg just walking up and down stairs instead of using a lift, or find an activity you enjoy, it ought to benefit mental health as well as physical health.

I agree with HH (who does say she lost quite a lot of weight) that excess weight is a burden on health. And it is obvious you know that too. What can you do to make even a small weight loss possible?

Would your GP refer you to a professional to advise you?

Steroid (even a six week taper) puts weight on me, so I see that your medication is not helping you avoid gaining weight. It is quite discouraging!

Although you had RA before weight gain, it is important to curb it if possible. Many get RA while active, fit and slim. So being overweight certainly is not considered a trigger for developing the disease. But it does not help in staying as healthy as possible.

I hope some of this is making sense.. I must get myself dressed soon; been up an hour but in pain all over.. hoping my biologic injections soon become effective. Fifth one tomorrow! 🙂

[AgedCrone in reply to helixhelix]

I agree trying to keep to a reasonable weight for your build & age is the way to go........but there must be one little variable missing.

How did you lose all that weight...was it just diet change & exercise?

When first diagnosed I was not over weight....I have not gained weight with RA...in fact some drugs made me lose weight.... but until I was prescribed my present medication my RA was out of control.

Many people without RA are not just overweight but obese.......so apart from those that eat themselves fat or have another medical condition....I do wonder .......does every overweight person with RA who loses the excess weight find an improvement in their condition?

I’m not suggesting being overweight should be discounted, but I’m sure if I was overweight I’d be a bit miffed if I wasn’t given any other medical help for my RA except being told to lose weight.

However if you are overweight because you live on junk food, drink copious amounts of alcohol & never do a minute’s exercise.....think about it......

[Mmrr in reply to AgedCrone]

Similar to my understanding.

I recently completed a MOOC on obesity, my oh my is it complex or what ! The biochemistry is difficult to get your head around, even with a wee bit prior knowledge.

The other big issue, not adequately addressed is how different we are to each other, it's not just things like height, eye and hair colour that are different, but our anatomy and biochemistry too.

Dame Professor Sue Black bangs on about how teaching anatomy and physiology to medical students via electronic means is catastrophic for the medical profession as we are all so different anatomically speaking. 1/10 'mistakes' in the surgical theatres are due anomalies in anatomy, an issue not made public, I'm not sure why.

Disection is the only way to fully understand the complexity of human beings. Dundee medical students still disesect due to her campaigns and funding of a new mortuary.

We need to really take care using the word causal with human beings.

[Hidden]

I only became over weight when I started my meds...... nothing I do will shift it.

[Mmrr in reply to Hidden]

Similar with me

[Hessie5]

Hi Elmo333 - just wanted to share I was underweight due to my RA and raging inflammation, - my markers often topped ESR 90 and CRP equally as high. I ate well, no smoking, no drinking but yet my body was so inflamed.

I just couldn't understand and decided that I am not getting hung up on the markers - they were just stressing me out. I decided to let go of thinking numbers and focus on trying to do the things I researched that can help lower the inflammation, part of that for me was to de-stress.

Although, still work in progress I press on. The meds are helping - I can't say what my markers are now, despite phone calls my consultant never calls back. Just wish there was a way I could have this to hand solely to monitor.

Speak with your consultant and put a plan in place that would help, this would include getting the right medication.

Is there any reason why you can’t lose the weight? Is it the meds causing the weight?

Hessie

[Ali_H in reply to Hessie5]

Hi Hessie,

I get my bloods result via a Patient Access app that lets me see my medical stuff and book appointments etc. It’s with my GP practice and I get my bloods there not at the rheumy dept as it’s harder to access info from them. The rheumy dept accesses the results via the GP records on line as well. It means I can keep track of all results and revisit them if I wish.

That may be a way forward for you if your GP practice has the online service.

Ali

[Hidden in reply to Ali_H]

Same here

[Hessie5 in reply to Ali_H]

Thanks Ali - unfortunately we don't have these facilities - still very archaic. Take care.

[Elmo333]

Yes, it’s the antipsychotic injections that I use for my bipolar disorder that are a nightmare for weight. My gp said I would have to eat less than 800 calories a day to lose weight and there’s just no way I could do that! I would rather be big than hungry and miserable all the time! I’m glad you’ve invested time into stress reduction, it sure doesn’t help when your brain is whirring all the time. I have to ask receptionists to print out my results every month, which they reluctantly do🙄x

[Eiram50 in reply to Elmo333]

Hi Elmo

I do understand your issue and sympathise. My daughter has bipolar disorder and is suffering the same way due to her anti psychotics. She’s only twenty and is very unhappy about it.

Strangely though, her psychiatrist offered her medication to combat the inevitable weight gain. It was a drug usually used with diabetes sufferers - can’t remember the name of it.

She did not accept it, feeling when took enough medication already but I guess there appears something out there to possibly help, if needed. X

[Elmo333 in reply to Eiram50]

Thank you. I’m sorry your daughter is going through it too. I was 22 and now at 37, I’ve still not lost it. I think it’s probably metformin which is also used for diabetes but like her, I am on so many medications🙄. X

[Eiram50 in reply to Elmo333]

Thank you.

It may well have been that drug but, I’m glad she didn’t add it to the rest. It’s a tough road.

Wishing you the very beat, going forward x

[HappykindaGal]

I’m overweight and the steroids only added to it. I’m still overweight and my CRP levels are now under 8. I’m not sure there’s any correlation between weight, RA and inflammation. Think it’s more the luck of the draw

[Ali_H]

Hi,

An interesting one because they (who ever ‘they’ are!) keep pushing the weight element but for myself it’s not so easily defined as an active contributor to RA. I am over weight and struggle to keep under 80kg (I’m 1m56 - 5’2” ) apparently my ‘ideal weight’ is about 56kg - that’s a ****** joke I haven’t seen that weight since I was about 12 years old! I feel comfortable at about 72-3kg and rarely go below 68kg. I’m not an active dieter but when physically more active can keep the weight down - I can’t work full time and keep my weight down for some reason!

Any way the point is I have RF negative; CRP positive RA that is relatively mild which hasn’t got worse when my weight is up. I am currently at the just under 80kg mark and have been reducing my MTX from 20mg to 12.5mg over the past 12 months so the weight not raising markers etc but funnily enough at 12.5mg things are a little unsettled so I’ve agreed to a GP exercise referral to see if getting my weight back down will allow me to keep at 12.5mg - I start Friday and let you know if I get anywhere or end up back on 15mg of MTX despite any weight loss!

All the best

Ali

[Mmrr]

I was slim, very fit and active weighed around 9 and a half stones, with a BMI of around 23 immediately before becoming unwell. I'm sero negative.

Within a few months I had gained over 3 stones (unmedicated at this point). Then the mixture of MTX and prednisolone seemed to exacerbate the weight gain and I gained almost another 2 stones, BMI over 35. Still sero negative.

Along come the biologic drugs and the weight slowly is coming off, I've lost a smidge off 2 and a half stones. My appetite is completely curbed, but the weight loss is so slow. My excessive thirst has gone. I'm still sero negative, still on prednisolone, still largely sedentary.

The evidence is there, obese people often have higher inflammitory markers; but it's far too simple to say it's causal. Besides anecdotal evidence suggests the excess weight gain seen in RD often has little to do with excess eating and/or the sedentary life style the disease often imposes. Perhaps something metabolic is going on too in some people ? This point was accepted in the past, but seems to have lost status with the big focus on joint deterioration in recent years.

RD is a collection of diseases of which we know very little, so little we are unable even to differentiate and hence classify them adequately. (And I'll bang the drum again, in our situation we still categorise by arthritis for goodness sake).

Treatment is by blanket cover, trial and error, with little scientific basis. (Here try this, not working ? Well try that instead; We have several drugs called X,Y and Z ...which would you prefer ?)

Science has relatively recently only accepted the complexity of many disease processes, autoimmune being unimaginably complex. I don't believe we are in a position to say with confidence this is causal to that. Far too big a step for now.

It's not unreasonable to believe a multitude of disease processes within RD all with their own little twists and turns, some of which obesity and inflammatitory markers are causal. Equally so, they are not for others, me for example !

[Gertzm in reply to Mmrr]

Good morning Everyone,

Going through all the mail on the subject of weight loss, I agree with what has been written, in reply .

In my family, we all are weighty people, from my Grandfather, and seems to have been handed down from generation, to generation. We all seem to be going through all the trials of loosing weight, and not winning in the process much as we try to obey the Doctors orders.

I feel loosing weight has to come from within you, and keeping up the courage that one can somehow keep it up for as long as one can. In my trials I have tried at certain times to cut off starches, and try once a week to keep away from the evil temptation of the odd bite, much as I love my hot cuppa and a nibble at something but that once a week does help a bit of detoxing. I eat anything that is available, but try not to load to satisfaction. I hope I have not wasted any ones time in sending this note, but I do put on weight very easily, and this has helped a little, am not slim over it, but I do feel a little lighter. Good day to you all..

[Mmrr in reply to Gertzm]

You have not wasted anyone's time, we are happy to have your contrubution.

The old adage of calories in , calories out whilst holding true, does not take account metabolic rate, effects of drugs etc etc

We are all diffefent.

[KittyJ in reply to Gertzm]

Of course you haven’t wasted anyone’s time Gertzm, your comment is very welcome 😊

[Pawz4me]

I think both obesity and RA are very complex diseases. I trust science to eventually sort things out, and I'm not sure any one anecdotal story means much of anything. But here's mine --

I went from a slightly chubby teen to an obese young adult, but in my mid-20's I managed to lose it all and get myself into a normal weight range, and there I've pretty much stayed for 30 years by closely watching calories and eating a mostly vegetarian, Mediterranean type diet. Losing weight and keeping it off is one of the hardest things I've ever done in my life. It. Is. Hard. For me it took over my whole life. Losing weight was like a project that I had to fully immerse myself in to be successful. Did I mention how hard it was?? I still have to watch my calorie intake very, very carefully every single day. My point here is not that I succeeded, but how incredibly hard it was. That's not meant to discourage anyone! Not at all! It's meant to sympathize. It was so very hard for me, and I wonder if I would have been able to do it if (1) I hadn't done it at a time in my life when I could fully focus on it and (2) while I was still fairly young, and perhaps before my body had too much time to decide that obesity was its normal state.

I still developed seropositive RA, but my inflammation markers have always been low. My rheumatologist seems to believe my markers are low in large part due to my diet. Weight hasn't been mentioned (maybe because mine is at a good place, I don't know), but he's a big fan of vegetarian, low processed food diets for people with RA. Now I've been eating that way for 30 years, so obviously it didn't do a thing to stop me from being diagnosed with RA last year. I suspect the best diet, lowest weight in the world doesn't overcome genetics. But is it possible that a normal body weight and/or the right diet helps minimize inflammation? Sure, I guess so. But again, I suspect genetics plays a role in that, too. We're all different, or at least variable to some extent. I don't think our bodies are like engines that all work exactly the same way, even when given the exact same fuel and put under the exact same load. Bodies are way too complex for that.

[Hidden]

My gran who had RA from age 30, was skinny as a rake all her life. I on the other hand take after my other nan who was quite a plump lady and never had any type of Arthritis. Both lived well into their 80s.