Does Tight RA Disease Control Improve Rheumatoid Cachexia?

Adhering to treat-to-target (T2T) treatment guidelines in rheumatoid arthritis (RA) did not appear to ameliorate rheumatoid cachexia in a cross-sectional study published in Rheumatology.  

It was previously postulated that tight RA disease control could possibly attenuate loss of muscle mass (MM) and increase total fat mass (TFM) seen with rheumatoid cachexia as the cachexia was thought to be driven by inflammatory processes. 

To examine effects of T2T RA treatment on MM and TFM, researchers at Bangor University, Liverpool, UK, evaluated 82 patients with RA being treated with T2T and 85 matched sedentary healthy controls (HCs) in a cross-sectional study. Dual-energy x-ray absorptiometry (DXA) was used to evaluate body mass composition, using appendicular lean mass as a surrogate marker of total MM.  

Objective measures of physical function included assessment of knee extensor strength, handgrip strength, 30 second sit-to-stands, 8 foot “up and go’s”, and 50 foot walks, testing effective ability to perform activities of daily living. 

Researchers found that when compared to matched sedentary HCs, patients with RA had approximately 10% less lean appendicular mass and approximately 27% more total body fat despite aggressive T2T treatment (mean DAS28 = 2.8).   

Physical function of patients with RA also remained 24-24% lower than matched controls despite tight disease control.

“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,” the authors noted. 

Summary and Clinical Applicability

T2T treatment did not reverse relative MM loss and total body fat accumulation in patients with RA. Furthermore, assessments of physical function did not change with T2T treatment as compared to pre-T2T patients with RA. 

Limitations and Disclosures

Surrogate measures of muscle mass were used and length of followup was limited. 

Reference

Lemmey AB, Wilkinson TJ, Clayton RJ, et al. Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients. Rheumatology (Oxford). 2016; Published online ahead of print June 10, 2016. doi:10.1093/rheumatology/kew243