Andrew B Lemmey1, Thomas J Wilkinson2, Rebecca J Clayton3, Fazal Sheikh3, John Whale2, Hope S J Jones2, Yasmeen A Ahmad3, Sarang Chitale3, Jeremy G Jones3, Peter J Maddison3, Thomas D O'Brien4. 1. Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor a.b.lemmey@bangor.ac.uk. 2. Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor. 3. Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd. 4. Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
Abstract
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.
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 RApatients. METHODS: A total of 82 RApatients 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), RApatients 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 RApatients 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 RApatients 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 RApatients. Thus T2T, even in responsive RApatients, did not attenuate rheumatoid cachexia or improve objectively assessed function.
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