TY - JOUR

T1 - Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients

AU - Lemmey, A.B.

AU - Wilkinson, Thomas

AU - Clayton, Rebecca

AU - Sheikh, F.

AU - Whale, J.

AU - Jones, H.

AU - Ahmad, Y.A.

AU - Chitale, S.

AU - Jones, Jeremy

AU - Maddison, P.

AU - OBrien, Thomas

N1 - This is a pre-copyedited, author-produced PDF of an article accepted for publication in Rheumatology following peer review. The version of record is available online at: http://rheumatology.oxfordjournals.org/content/early/2016/06/05/rheumatology.kew243

PY - 2016/6/10

Y1 - 2016/6/10

N2 - Objective. RA typically features rheumatoid cachexia [loss of muscle mass (MM) and excessive total fat mass (TFM), especially trunk FM], which contributes to physical disability. Since rheumatoid cachexia is driven by inflammation, it would be anticipated that the success of tight control of disease activity, such as treat-to-target (T2T), in attenuating inflammation would benefit body composition and physical function. This aim of this cross-sectional study was to assess the impact of T2T on body composition and objectively assessed function in RA patients.Methods. A total of 82 RA patients exclusively treated by T2T, were compared with 85 matched sedentary healthy controls (HCs). Body composition was estimated by DXA, with appendicular lean mass the surrogate measure of total MM. Physical function was assessed by knee extensor strength, handgrip strength, 30 s sit-to-stands, 8′ up and go, and 50′ walk (tests which reflect the ability to perform activities of daily living).Results. Although generally well treated (mean DAS28 = 2.8, with 49% in remission), RA patients had ∼10% proportionally less appendicular lean mass and were considerably fatter (by ∼27%), particularly in the trunk (∼32%), than HCs. All measures of function were 24–34% poorer in the RA patients relative to HC.Conclusions. Despite marked improvements in disease control (most patients achieving or approaching remission), the relative loss of MM and increased adiposity in RA patients compared with matched HCs was similar to that observed pre-T2T. Additionally, performance of objective function tests was unchanged from that reported by our group for pre-T2T RA patients. Thus T2T, even in responsive RA patients, did not attenuate rheumatoid cachexia or improve objectively assessed function.

AB - Objective. RA typically features rheumatoid cachexia [loss of muscle mass (MM) and excessive total fat mass (TFM), especially trunk FM], which contributes to physical disability. Since rheumatoid cachexia is driven by inflammation, it would be anticipated that the success of tight control of disease activity, such as treat-to-target (T2T), in attenuating inflammation would benefit body composition and physical function. This aim of this cross-sectional study was to assess the impact of T2T on body composition and objectively assessed function in RA patients.Methods. A total of 82 RA patients exclusively treated by T2T, were compared with 85 matched sedentary healthy controls (HCs). Body composition was estimated by DXA, with appendicular lean mass the surrogate measure of total MM. Physical function was assessed by knee extensor strength, handgrip strength, 30 s sit-to-stands, 8′ up and go, and 50′ walk (tests which reflect the ability to perform activities of daily living).Results. Although generally well treated (mean DAS28 = 2.8, with 49% in remission), RA patients had ∼10% proportionally less appendicular lean mass and were considerably fatter (by ∼27%), particularly in the trunk (∼32%), than HCs. All measures of function were 24–34% poorer in the RA patients relative to HC.Conclusions. Despite marked improvements in disease control (most patients achieving or approaching remission), the relative loss of MM and increased adiposity in RA patients compared with matched HCs was similar to that observed pre-T2T. Additionally, performance of objective function tests was unchanged from that reported by our group for pre-T2T RA patients. Thus T2T, even in responsive RA patients, did not attenuate rheumatoid cachexia or improve objectively assessed function.

KW - Rheumatoid Arthritis

KW - Treat-to-target

KW - Rheumatoic Cachexia

KW - Body Composition

KW - Physical Function

U2 - 10.1093/rheumatology/kew243

DO - 10.1093/rheumatology/kew243

M3 - Article

VL - 55

SP - 1736

EP - 1745

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 10

ER -