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Obesity and RA — Wait! There’s More!

We all know the drill. Excess weight is hard on the joints. It’s estimated that every pound of weight puts four pounds of pressure on your knees (or more, depending on the source). It’s also bad for your heart and lungs which can further complicate some side effects of the many drugs that RA patients take.

But now there’s more. There’s a new study out that indicates that excess weight causes RA to manifest earlier than in people with a normal weight and draws some conclusions as to why people who are overweight respond more slowly to RA treatments. (The study is summarized in a news story here and was originally published here.)

It’s an interesting study and I encourage you to read either the news story or the study itself. This is a simplified explanation but the study was done on mice and the scientists found that the fat cells in joints attracted inflammation, causing the onset on RA sooner. Since the fat cells attracted more inflammation, it took longer for the drugs to resolve it. Even though they were studying mice, the study results are pretty directly applicable to humans.

So yet another compelling argument to lose those excess pounds.

Let me just say this about that. If you have RA, it’s very hard not to have some extra pounds and once you have them, it’s even tougher to get rid of them. As much as I recognize and appreciate the guidance, I’m really tired of hearing it from people (healthcare providers included) who don’t grasp the difficulties we face.

First, joint pain makes it difficult to exercise – particularly the cardio or weight routines recommended for weight loss. I will tell you that during a flare, getting out of bed is sometimes as much “exercise” as I can manage. On those days I might as well try to fly as to try to manage the suggested 10,000 daily steps.

Compounding the pain issue is the fact that some drugs used to treat RA, steroids in particular, actually list weight gain as a side effect. I had recently (finally) lost some pounds I put on while taking prednisone when my scale started to creep back up and I couldn’t figure out why. It turns out that a drug I was temporarily taking for nerve pain also causes weight gain. And just because you stop taking the drug doesn’t mean that the weight comes off. Unfortunately, it doesn’t work that way.

Another weight-related issue is age. While RA can and does strike people of all ages, according to the CDC, the onset of RA is most frequent for people in their sixties. This is the time when menopausal changes occur in women and metabolism slows for both men and women. Both of these factors are related to weight gain.

I’m not saying that losing weight can’t be done or that it shouldn’t be done. Patting myself on the back for a moment, I’ve lost about 25 pounds over the past year. It’s been really good for me in numerous ways. But it hasn’t been easy and I still have some pounds to go before I’m down where my doctor and I would like me to be.

Those of us with RA know how important diet, exercise, and a healthy weight are. All I’m asking is a little compassion and understanding here for those of us who deal with the challenges of this disease on a daily basis.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Connie Rifenburg
    3 years ago

    Carla, your comment regarding prednisone and diabetes and overweight problems is right on! When I’m hospitalized with pneumonia or anything basically, I am put on IV prednisone and within a day, I have to begin receiving shots of insulin with blood sugars in the 300s!

    Because I take prednisone regularly (5mg daily)is my lowest in the past 6-7 yrs, I have gained over 100 lbs in the 13 yrs since I was diagnosed. Every time I have to go up on the dose of prednisone for flares or other things (as mentioned above) the weight continues to add on.

    I was a skinny kid and an average weight adult – generally never more than 5 lbs over normal weight for my size/age. But due to so many years of taking steroids and the advancement of my RA and added Osteoarthritis which limits exercise to mostly water movement when possible, my weight has continued to be 100 lbs overweight.

    Diabetes type II is always associated with my weight and my A1c number is generally 6.3-6.5 which is “borderline” diabetic for adding medication. But I know that dieting will not help me lose the weight that is put on by the steroid. It accumulates in the strangest places like the hump on the back of my neck, my central body area-chest, waist, stomach, hips. I know those are normal areas to add weight to, but this type of steroid weight is fat, fat, fat. It’s the rounding of my once angular face into a pumpkin that signifies my weight is steroid caused.

    My doctors are generally good about my weight as I continue to weigh the same from yr to yr w/just a lb or so each yr after the initial steroid gain. But when you add in age (now 65)and post menopause to the lessening of exercise, what can you expect.

    Other than keeping “good” snacks in my house, steroid eating is well documented and it is hell to fight!! It feels as if the switch in your brain that tells you you’re full has been turned off, and the signal to eat constantly urges you to put something in your mouth!! Ha!

    I wonder if I had continued to smoke whether that might have helped stave off the weight gain…but to trade one negative for another makes no sense.

    As I said, if there were an antidote to the steroid weight like insulin is to diabetics, it would be a miracle drug for many of us… not just RA but people who have asthma or other diseases that cause them to use a steroid to treat it.

    Until that time, I have to tell myself that prednisone is a “gift” drug. One that helps during those times of severe inflammation when no other drug works. And I pity those people who went before us that didn’t have this drug to bring down inflammation at all. I can’t imagine the pain they endured.

    I remember, at age 15, working in a nursing home and caring for a lady (I considered old-40s) who was so crippled and stiff with RA that it was like trying to move a very fragile piece of shell. She creaked and her bones audibly rubbed against each other with even the smallest movement. I will always remember her sweet face smiling as we tried to change her bed or move her to sit up to eat. My first experience with her caused me to go to the ladies room and cry until I was back under control. That was in the 1960s.

    We have come a long way, but I believe we won’t find a cure until we are able to use stem-cell treatments to target the cells that are damaged and replace them with clean, healthy cells. It may not be in my lifetime, but I pray it will be in the lifetime of my grandchildren so they will never know RA personally.

    Sorry for the long post – I guess this article hit a sensitive nerve. On to a new year and better treatments without steroids.

  • Carla Kienast author
    3 years ago

    Hi Connie: No need to apologize for the long post — you have quite a story to share and I am so glad you did. I have a love/hate relationship with steroids — I love the effects but I hate the side effect — and high glucose and weight gain are two of the hardest to combat. Thank you for responding to the article and do come back often! (And may 2017 be healthy and happy for all of us!)

  • Wren moderator
    3 years ago

    An interesting study, and yet another good reason to both keep the excess weight off if you don’t have RD and if you do and take drugs for it.

    That said, I was not overweight or obese when I was diagnosed, and was very active. Why did I get RD? I guess I didn’t hold my mouth right, or something. 😉

    I’m right with you regarding the difficulty we face in losing weight, though, Carla. It’s a real problem, and one that affects our mental health at least as much as physical health. It would be great if science could come up with an effective pill for that, wouldn’t it?

    Wonderful post! 🙂

  • Carla Kienast author
    3 years ago

    Hi Wren: I guess no one said it was going to be easy. 🙂 Wishing you and yours a great holiday and a really healthy happy 2017.

  • Larry Sawyer
    3 years ago

    Having always been on the scrawny side, I find flairs and fatigue impediments to working out and controlling my weight, so another exception to a “study” about RA. noot whining, just referring to the old adage that RA is complex and the researchers are still nibbling at the edges. Uffda as my Norwegians says. I say Merry Christmas

  • Carla Kienast author
    3 years ago

    Truer words have never been spoken than RA is complex. I think the more the researchers figure out, the more complex it becomes. And a Merry Christmas right back atcha!

  • Lawrence 'rick' Phillips moderator
    3 years ago

    Carla, as you can likely imagine I have a particular interest in the incidence of diabetes in people with RA. It is suspect that between 15% and 20% of people with RA also have type 2 diabetes (We do not know a more accurate estimate because the matter has never been fully studied). The matter is incredibly important because it may help quality of life, if as part of regular blood work a simple blood glucose was included.

    I am hopeful that researchers will take this type of study on in the near future. When read about this study my hopes were raised. Up until this time, the incidence of diabetes has been blamed on weight gain associated with having RA.

    However, it is just as possible that a metabolic change happens that cause people to gain weight. To my knowledge, we are still trying to figure that out in all populations. Regardless, information about Weight, RA and Diabetes fit like a tight glove. This study helps us get one step closer.

  • Carla Kienast author
    3 years ago

    I’ve often wondered about the role that glucosteroids such as prednisone play in the apparent relationship between RA and diabetes. Prednisone is notorious for elevating blood glucose levels. I’m sure it’s a complex answer and may also involve inflammation of the insulin-producing pancreas. Whatever the reason, let’s hope they find answers soon.

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