Rheumatoid cachexia: depletion of lean body mass in rheumatoid arthritis. Possible association with tumor necrosis factor.
ABSTRACT To investigate body composition and serum tumor necrosis factor (TNF) levels in a series of 24 patients with rheumatoid arthritis (RA).
Body composition assessment by anthropometric measures and bioelectrical impedance. Cytokine determination in serum by ELISA:
When compared to United States population norms, 16 of the subjects (67%) were cachectic. In regression models, lean body mass (LBM) was inversely associated with the number of swollen joints (p < 0.025). Elevated TNF-alpha was found in 3 of 5 flaring patients vs 0 of 18 patients with less active disease (p = 0.001). These 3 were all cachectic, while the 2 flaring patients without detectable TNF had normal LBM (p < 0.03). Among the whole group, there was a trend toward increasing disability with decreased LBM after adjusting for joint pain and disease duration (p < 0.07).
Cachexia is common in RA, and may be cytokine driven. Given the prognostic impact of LBM wasting in other diseases, the effect of rheumatoid cachexia on outcome in RA deserves further study.
SourceAvailable from: Ahmet Yigit Goktay[Show abstract] [Hide abstract]
ABSTRACT: Objective: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). Increased body fat, particularly its central distribution, is a well-known risk factor for CVD. A change in body composition in RA has been described previously. However, in most of these studies, age- and sex- but not body mass index (BMI)-matched controls were used. The aim of this study was to evaluate body composition in RA patients and compare it with age-, sex-, and BMI-matched controls. Material and Methods: Sixty-five RA patients (55 females and 10 males; mean age 54.9 ± 10.8) and 31 healthy controls (25 females, 6 males; 53.8±8.6) were included in this study. Mean disease duration was 9.2±9.6 years. Body composition was assessed by anthropometric methods (skinfold thicknesses, body circumferences), bioimpedance analysis, and dual-energy X-ray absorptiometry (DXA). Visceral adipose tissue (VAT) was assessed with computed tomography. Results: There were no significant differences for total body fatness, regional fat distribution, and total body water and fat-free mass between RA patients and control subjects. Bone mineral content (BMC), assessed by DXA, was significantly lower in RA patients (p=0.004). Clinical disease activity indices and steroid treatment do not affect soft tissue body composition or BMC. Conclusion: At least some RA patients do not have soft tissue composition alterations and may have similar health risks in comparison with subjects with similar age, sex, and total adiposity.09/2014; 1:106-110. DOI:10.5152/eurjrheumatol.2014.035
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ABSTRACT: Background/Aims Increased resting energy expenditure (REE) in rheumatoid arthritis (RA) patients is thought to be caused by hypermetabolism associated with production of proinflammatory cytokines. Our aim in the present study was to explore the possible association between REE and disease activity in females with RA. Methods A total of 499 female RA patients were recruited to this cross-sectional study assessing REE scores on disease activity indices (the routine assessment of patient index data 3 [RAPID3], the disease activity score 28, and the clinical/simplified disease activity index [CDAI/SDAI]) and the levels of RA-associated autoantibodies (rheumatoid factor and anticyclic citrullinated peptide [anti-CCP] antibodies). Age-matched healthy female controls (n = 131) were also enrolled. Results REE did not differ between RA patients (all patients, and those in remission or not) and controls, or between RA patients in remission or not (p > 0.05 for all comparisons). Increased REE in total RA patients was associated with younger age and a higher body mass index (BMI) (p < 0.001 and p < 0.001, respectively), but not with disease activity index scores on any of RAPID3, CDAI, or SDAI. BMI was the only clinical parameter exhibiting a significant relationship with REE quartiles (Q1 to Q4; p < 0.001); none of disease duration, functional status, or anti-CCP antibody titer in RA patients was significantly related to REE, based on analysis of covariance. Conclusions We found no association between REE and disease activity in RA patients, implying that energy metabolism in RA patients might be independent of RA-associated systemic inflammation.The Korean Journal of Internal Medicine 07/2014; 29(4):516-24. DOI:10.3904/kjim.2014.29.4.516
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ABSTRACT: Purpose: We aimed to determine if there were gender differences in lean body mass (LBM) in patients with RA when compared with sex- and race- specific National Health and Nutrition Examination Survey (NHANES) reference data, and investigated the impact of sex differences in risk factors for LBM deficits.Methods: DXA measures of whole body LBM and appendicular LBM (arms and legs, ALM) were obtained on a total of 190 subjects from two independent cohorts (141 from San Francisco (SF), 49 from Philadelphia (PA)), expressed as indices adjusted for height (LBMI and ALMI, kg/m2), and converted to sex- and race- specific Z-scores relative to age based on NHANES data. Sarcopenia was defined using four different sex-specific definitions. Multivariable linear and logistic regression adjusted analyses for disease activity, disease duration, physical activity, CCP seropositivity, fat mass index, and glucocorticoid use.Results: While there were significant differences between the two cohorts, ALMI Z-scores were significantly lower in men compared to women in both (SF: -1.43 v. -0.43, p<0.0001; PA: -0.83 v. -0.06, p=0.03). Observed gender differences were significant after adjustment in multivariable analyses within both cohorts. Odds of sarcopenia were 3 to 8 times greater in men in the SF cohort. Men in the PA cohort also had a higher, but non-significant, risk of sarcopenia.Conclusion: RA is associated with significant LBM deficits, with greater deficits observed in men. Future study may help elucidate the mechanisms driving greater deficits among men. © 2014 American College of Rheumatology.01/2015; 67(1). DOI:10.1002/acr.22396