Cachexia and adiposity in rheumatoid arthritis. Relevance for disease management and clinical outcomes

Challal, Salima; Minichiello, Émeline; Boissier, Marie‐Christophe; Semerano, Luca

doi:10.1016/j.jbspin.2015.04.010

Cited by 59 publications

(47 citation statements)

References 59 publications

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“…Previous studies reported 37–57% male RA patients and 13–43.3% female RA patients having myopenia under different definitions . Decreased skeletal muscle mass especially appendicular muscle was shown to be associated with low physical function in RA . However, the association of myopenia with RA joint destruction has not been reported.…”

Section: Discussionmentioning

confidence: 98%

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Myopenia is associated with joint damage in rheumatoid arthritis: a cross‐sectional study

Lin

Liang

et al. 2019

J cachexia sarcopenia muscle

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Background The link between body mass index (BMI) and disease characteristics in rheumatoid arthritis (RA) remains controversial. Body composition (BC) has been more frequently recommended to be used instead of BMI for more accurate assessment. Our study aimed to investigate the characteristics of BC in RA patients and their associations with disease characteristics. Methods Body composition was assessed in consecutive Chinese RA patients and control subjects by bioelectric impedance analysis. Overfat was defined by body fat percentage (BF%) as ≥25% for men and ≥35% for women. Myopenia was defined by appendicular skeletal muscle mass index (ASMI) ≤7.0 kg/m 2 in men and ≤5.7 kg/m 2 in women. BMI and clinical data including disease activity, function, and radiographic assessment were collected. Active disease was defined by disease activity score in 28 joints with four variables including C‐reactive protein (DAS28‐CRP) ≥2.6. Functional limitation was defined as Stanford health assessment questionnaire disability index (HAQ‐DI) >1. Radiographic joint damage (RJD) was defined as the Sharp/van der Heijde modified sharp score (mTSS) >10. Results There were 457 RA patients (mean age 49.5 ± 13.1 years old with 82.7% women) and 1860 control subjects (mean age 34.3 ± 9.9 years old with 51.2% women) recruited. Comparisons of BMI and BC between RA patients and control subjects in age and gender stratification showed that lower BMI with 17.7% underweight and lower ASMI with 45.1% myopenia are the main characteristics in RA patients. Compared with those without myopenia, RA patients with myopenia had significantly higher DAS28‐CRP (median 3.5 vs. 3.0), higher HAQ‐DI (median 0.38 vs. 0.13) with higher rate of functional limitation (24.8% vs. 7.6%), and higher mTSS (median 22.3 vs. 9.0) with more RJD (71.8% vs. 45.8%) (all P < 0.001). Multivariate logistic regression analysis showed myopenia were positively associated with functional limitation (OR = 2.546, 95% CI: 1.043–6.217) and RJD (OR = 2.660, 95% CI: 1.443–4.904). All RA patients were divided into four BC subgroups according to overfat and myopenia. Those with both overfat and myopenia had the worst disease characteristics. After adjustment for confounding factors, significant additive interactions were observed between overfat and myopenia in active disease (AP = 0.528, 95% CI: 0.086–0.971), functional limitation (AP = 0.647, 95% CI: 0.356–0.937), and RJD (AP = 0.514, 95% CI: 0.139–0.890). Conclusions Myopenia is very common in RA patients that is associated with functional limitation and joint damage in RA. Further research on the underlying mechanism and the effect of skeletal muscle mass improvement in RA management are worth exploring in the future.

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Section: Discussionmentioning

confidence: 98%

“…Rheumatoid cachexia is characterized by loss of muscle with or without weight loss in the presence of stable or increased fat mass. Although there is no consensus criterion for diagnosis of rheumatoid cachexia, it has been reported ranging from 17% to 60% in RA …”

Section: Introductionmentioning

confidence: 99%

Myopenia is associated with joint damage in rheumatoid arthritis: a cross‐sectional study

Lin

Liang

et al. 2019

J cachexia sarcopenia muscle

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“…In our RA cohort, we did not find any significant association between BMI and outcomes. BMI is a validated index assessing obesity at the whole-body level; however, during RA, in which sarcopenia alters the body composition, BMI may not be considered a valid predictor of CVEs and subclinical atherosclerosis as in normal population [36,37]. Although other anthropometric measures of central adiposity, such as waist circumference and waist to hip ratio, have been proposed as alternatives to BMI [36,37], further studies are needed to identify the optimal method to assess the potential role of obesity as a predictor for CV comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Increased Cardiovascular Events and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients: 1 Year Prospective Single Centre Study

et al. 2017

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ObjectivesSeveral studies showed the close relationship between Rheumatoid Arthritis (RA) and cerebro-cardiovascular events (CVEs) and subclinical atherosclerosis. In this study, we investigated the occurrence of CVEs and subclinical atherosclerosis during the course of RA and we evaluated the possible role of both traditional cardiovascular (CV) and disease related risk factors to predict the occurrence of new CVEs and the onset of subclinical atherosclerosis.MethodsWe designed a single centre, bias-adjusted, prospective, observational study to investigate, in a homogeneous subset of RA patients, the occurrence of new onset of CVEs and subclinical atherosclerosis. Statistical analyses were performed to evaluate the role of traditional CV and disease-related risk factors to predict the occurrence of new CVEs and subclinical atherosclerosis.ResultsWe enrolled 347 RA patients prospectively followed for 12 months. An increased percentage of patients experienced CVEs, developed subclinical atherosclerosis and was affected by systemic arterial hypertension (SAH), type 2 diabetes mellitus and metabolic syndrome (MS), at the end of follow up. Our analysis showed that the insurgence of both SAH and MS, during the follow up, the older age, the CVE familiarity and the lack of clinical response, were associated with a significantly increased risk to experience CVEs and to develop subclinical atherosclerosis.ConclusionsOur study quantifies the increased expected risk for CVEs in a cohort of RA patients prospectively followed for 1 year. The occurrence of both new CVEs and subclinical atherosclerosis in RA patients may be explained by inflammatory burden as well as traditional CV risk factors.

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“…Since the exact causes of RC are not fully delineated, no definite preventive or therapeutic strategies have been tested to-date [7]. The introduction of target cytokine therapy such us anti-TNFα may provide an opportunity to address this problem, but this requires prospective assessment [46].…”

Section: Pharmacology Therapeutic Strategy Of Rheumatoid Cachexiamentioning

confidence: 99%

“…This combined condition has been called "rheumatoid cachexia" (RC) [7]. In recent decades, the concept of rheumatoid cachexia has received more consideration [5] based on the understanding of how nutritional alterations affect patient quality of life, evolution and the prognosis of rheumatologic conditions such us increased risk of cardiovascular disease and osteoporosis [8,9].…”

Section: Introductionmentioning

confidence: 99%

Rheumatoid Cachexia, a Metabolic Rheumatoid Arthritis Disorder: Pathophysiological Mechanisms, Diagnostic Tools and Current Therapeutic Strategy

Ghozlani¹

2017

EMIJ

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Cachexia and adiposity in rheumatoid arthritis. Relevance for disease management and clinical outcomes

Cited by 59 publications

References 59 publications

Myopenia is associated with joint damage in rheumatoid arthritis: a cross‐sectional study

Myopenia is associated with joint damage in rheumatoid arthritis: a cross‐sectional study

Increased Cardiovascular Events and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients: 1 Year Prospective Single Centre Study

Rheumatoid Cachexia, a Metabolic Rheumatoid Arthritis Disorder: Pathophysiological Mechanisms, Diagnostic Tools and Current Therapeutic Strategy

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