BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disease characterized by increased mortality associated with cardiometabolic disorders including dyslipidaemia, insulin resistance, and cachectic obesity. Tumour necrosis factor inhibitors and interleukin 6 receptor blocker licensed for the treatment of RA decrease inflammation and could thus improve cardiovascular risk, but their effects on body composition and metabolic profile need to be clarified. We investigated the effects of tocilizumab (TCZ), a humanized anti‐interleukin 6 receptor antibody, on body composition and metabolic profile in patients treated for RA.MethodsTwenty‐one active RA patients treated with TCZ were included in a 1 year open follow‐up study. Waist circumference, body mass index, blood pressure, lipid profile, fasting glucose, insulin, serum levels of adipokines and pancreatic/gastrointestinal hormones, and body composition (dual‐energy X‐ray absorptiometry) were measured at baseline and 6 and 12 months of treatment. At baseline, RA patients were compared with 21 non‐RA controls matched for age, sex, body mass index, and metabolic syndrome.ResultsCompared with controls, body composition was altered in RA with a decrease in total and appendicular lean mass, whereas fat composition was not modified. Among RA patients, 28.6% had a skeletal muscle mass index below the cut‐off point for sarcopaenia (4.8% of controls). After 1 year of treatment with TCZ, there was a significant weight gain without changes for fat mass. In contrast, an increase in lean mass was observed with a significant gain in appendicular lean mass and skeletal muscle mass index between 6 and 12 months. Distribution of the fat was modified with a decrease in trunk/peripheral fat ratio and an increase in subcutaneous adipose tissue. No changes for waist circumference, blood pressure, fasting glucose, and atherogenic index were observed.ConclusionsDespite weight gain during treatment with TCZ, no increase in fat but a modification in fat distribution was observed. In contrast, muscle gain suggests that blocking IL‐6 might be efficient in treating sarcopaenia associated with RA.

BackgroundEvaluation of sarcopenia is of major relevance because of these clinical repercussions on morbidity and mortality. Although the definition should include both low muscle mass and function, a combination of the 2 criteria was not reported in inflammatory rheumatic diseases (IRDs).ObjectivesTo determine in a cohort of IRDs the prevalence of sarcopenia using established combined criteria (EWGSOP) (1).MethodsSarcopenia defined as both low muscle mass (skeletal muscle index (SMI) <7.26 kg/m2 for men; <5.45 kg/m2 for women) and impaired muscular function (handgrip strength or gait speed) (1) was assessed in active rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsoA) patients before initiating first biologic. Body composition (DXA) and related factors were compared using univariate, multivariate and correlation analysis.Results148 patients were included (Table). Sarcopenia with decrease in muscle mass and function was observed in 5 RA (7.8%), one SpA (1.7%) and one PsoA (9.1%). Sarcopenia in terms of reduced SMI only (1) was not more frequent occuring in 5 RA (7.8%), 3 SpA (5.1%) and one PsoA (9.1%). Grip strength was decreased in RA as well as muscle mass compared to SpA and PsoA but the difference was no longer significant when adjusted on age, sex, disease duration (Table). Only fat distribution differed with a trunk/peripheral fat ratio higher in PsoA. In RA, lean mass was negatively correlated with disease duration and sedentary time. In SpA and PsoA, fat mass was correlated with age, disease activity, HAQ. HAQ and CRP level negatively correlated with lean mass. No association between treatments and body composition was observed.Table 1.Characteristics and body composition of patients with RA, SpA, PsoA [mean±SD; n (%)]RA (n=74)SPA (n=63)PsoA (n=11)p/p* Age, years59.5±11.744.1±12.054.6±11.0<0.0001Women54 (73)27 (43)6 (55)0.001Disease duration, years9±15.96.4±9.45.5±6.80.4Body Mass Index25.8±6.326.6±5.828.7±5.10.3DAS284.37±1.082.78±0.913.63±1.06<0.0001BASDAI50.8±17.249.6±17.70.8HAQ0.9±0.60.7±0.51.0±0.70.09CRP, mg/l16.4±21.311.9±14.310.7±13.60.3MTX54 (73.0)6 (9.5)6 (54.6)<0.0001Steroids41 (55.4)1 (1.6)1 (9.1)<0.0001NSAIDs18 (24.3)38 (60.3)7 (63.6)<0.0001Total lean mass, kg46.7±10.853.3±11.151.1±9.8 0.004/0.6SMI, Kg/m27.2±1.48.1±1.68.0±1.7 0.009/0.5Total fat mass, kg21.9±8.121.8±10.325.5±10.70.5/0.1Fat mass index (FMI), kg/m28.2±3.27.8±4.29.6±4.30.3/0.05Overfat (Body fat percentage >27% for men and 38% for women)18 (28)18 (30.5)4 (36)0.8Trunk/peripheral fat ratio0.97±0.300.99±0.331.23±0.26 0.04/0.02 *Adjusted for age, sex, disease duration.ConclusionsSarcopenia with combined criteria (muscle mass and function) occurred in 7.8% of RA corresponding to the values of the general population aged over 70 years-old (2). Reduced muscle mass only was not highly prevalent and lower than that reported in elderly suggesting important cofactors such as functional limitations or muscle quality in sarcopenia associated with rheumatic diseases.References Cruz-Jentoft AJ et al. Age Ageing 2010;39...

The retention rate in SpA patients proved high, with retention for IFX superior to that of ETN.

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In real life, there was no difference in retention among the three anti-TNF agents, and 25% of patients continued them at 15 years. After failure of an anti-TNF, the switch to a non-anti-TNF biotherapy showed better retention.