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Santo RCDE, Baker JF, Santos LPD, Silva MMMD, Xavier RM. Sarcopenia in Immune-Mediated Rheumatic Diseases-Review. J Clin Rheumatol 2023; 29:354-362. [PMID: 36322934 DOI: 10.1097/rhu.0000000000001913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Sarcopenia is a condition characterized by decreased muscle strength and muscle mass, which can impact physical function. Sarcopenia develops as a consequence of age-related decline (primary sarcopenia) and has a major impact on physical, social, and emotional well-being. In addition, patients with rheumatic diseases may suffer from sarcopenia independently of aging (secondary sarcopenia). Exercise, pharmacological treatments, and nutritional supplementation are some of the strategies used for the management of sarcopenia in the general population. The aim of this review is to summarize the evidence around the prevalence and impact of sarcopenia in patients with rheumatic diseases. CONCLUSIONS From our review, we can state that sarcopenia is a common and prevalent condition among the rheumatic diseases. Furthermore, the impacts of sarcopenia are not well-appreciated, and the implementation of treatment strategies has not been widespread. Strategies such as exercise and some pharmacological treatments are effective in improving physical and functional impairment related to these conditions. FUTURE RESEARCH DIRECTIONS IN THE FIELD New pharmacological treatments are being actively studied and may contribute in the future to the management of sarcopenia.
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Affiliation(s)
- Rafaela Cavalheiro do Espírito Santo
- From the Laboratório de Doenças Auto Imunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center and the University of Pennsylvania, Philadelphia, PA
| | - Leonardo Peterson Dos Santos
- From the Laboratório de Doenças Auto Imunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Ricardo Machado Xavier
- From the Laboratório de Doenças Auto Imunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Cano-García L, Redondo-Rodríguez R, Manrique-Arija S, Domínguez-Quesada C, Crisóstomo Vacas J, Armenteros-Ortiz P, Ruiz-Vilchez D, Martín-Martín JM, García-Studer A, Ortiz-Márquez F, Mena-Vázquez N, Fernández-Nebro A. Prevalence of Malnutrition and Associated Factors in Older Patients with Rheumatoid Arthritis: A Cross-Sectional Study. Nutrients 2023; 15:3500. [PMID: 37630691 PMCID: PMC10460011 DOI: 10.3390/nu15163500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE To describe the frequency of malnutrition in older patients with rheumatoid arthritis (RA) and investigate associated risk factors. METHODS This multicenter, cross-sectional study included participants aged ≥65 years who met the 2010 ACR/EULAR criteria for RA. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF) and based on variables, such as albumin level, the Geriatric Nutritional Risk Index (GNRI), and vitamin D. Data were also collected on epidemiological variables, inflammatory disease activity, quality of life, physical function, and frailty. Multivariate models were used to study factors associated with nutritional status. RESULTS The study population comprised 76 RA patients aged ≥65 years, of whom 68.4% had a normal nutritional status, and 31.5% had an impaired nutritional status: 28.9% were at risk of malnutrition, and 2.6% were malnourished. Additionally, 10% had albumin levels <3.8 g/L. Patients with impaired nutritional status had poorer quality of life and physical function. The factors associated with compromised nutritional status (OR [95% CI]) were age (1.0 [1.0-1.1]; p = 0.035), DAS28-ESR (1.8 [1.0-3.2]; p = 0.024), and EuroQoL-5D-5L (0.9 [0.9-0.9]; p = 0.040). Furthermore, the GNRI was associated with the MNA score (0.06 [0.0-0.1]; p = 0.014). CONCLUSIONS Approximately one-third of older patients with RA have impaired nutritional status. Older age, higher inflammatory disease activity, and decreased quality of life are associated with impaired nutritional status. The MNA and GNRI are valuable tools for assessing the nutritional status of patients with RA.
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Affiliation(s)
- Laura Cano-García
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Rocío Redondo-Rodríguez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, 29010 Málaga, Spain
| | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, 29010 Málaga, Spain
| | | | - Juan Crisóstomo Vacas
- UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain; (J.C.V.); (P.A.-O.); (D.R.-V.)
| | - Pedro Armenteros-Ortiz
- UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain; (J.C.V.); (P.A.-O.); (D.R.-V.)
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - Desiree Ruiz-Vilchez
- UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain; (J.C.V.); (P.A.-O.); (D.R.-V.)
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - José María Martín-Martín
- UGC de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | - Aimara García-Studer
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Fernando Ortiz-Márquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, 29010 Málaga, Spain
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Effects of biologic and target synthetic disease-modifying anti-rheumatic drugs on sarcopenia in spondyloarthritis and rheumatoid arthritis: a systematic review and meta-analysis. Clin Rheumatol 2023; 42:979-997. [PMID: 36462127 DOI: 10.1007/s10067-022-06454-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/04/2022]
Abstract
Sarcopenia is a syndrome defined by generalized and progressive loss of skeletal muscle mass, strength, and function. Besides affecting elderly population, it is actually common among inflammatory rheumatic diseases (IRD) patients. We performed a systematic literature review with a meta-analysis to investigate the influence of biologic and target synthetic disease-modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) on sarcopenia in IRD. A systematic search has been performed on Pubmed, Scopus, and Web of science. Studies characteristics were collected. Assessment tools were body composition (total lean mass (TLM) and percentage, appendicular skeletal mass (ASM), fat-free mass and index (FFM and FFMI), skeletal mass index (SMI) and segmental lean mass (SLM)), and muscle strength and physical performance tests. Treatment effect defined the difference in change from baseline to the end of follow-up treatment was divided by the pooled SD of the difference. Twenty-two studies on 778 patients receiving bDMARDs/tsDMARDs and 157 controls were reviewed. They investigated rheumatoid arthritis (RA) (N = 14), spondyloarthritis (SpA) (N = 6), psoriatic arthritis (N = 1), and both RA and SpA (N = 1). tsDMARDs were used in one study with no effect on sarcopenia. Ten studies demonstrated that bDMARDs increased significantly muscle measures in 347 patients (44.6%) with a significant increase in TLM (6/15 studies; 57.4%), FFMI (4/6 studies; 59.9%), ASM (2/5 studies; 17.6%), SMI (2/5 studies; 18.1%), and SLM (2/2 studies; 3.6%). bDMARDs showed also a positive effect on handgrip strength in 1/3 of studies (45.2%) and on physical performance in 1/2 of studies (61%). In 1/5 of comparative studies, IRD patients on bDMARDs showed significantly higher increase of TLM in comparison to controls naïve bDMARDs. Regarding diagnosis, positive effect of bDMARDs was seen in 67.4% in SpA versus 49.3% in RA, with a significant increase of TLM, ASM and FFMI in 59.4%, 100%, and 65.2% in SpA versus 54.9%, 24.1%, and 54.8% in RA, respectively. Meta-analysis assessed the effect of bDMARD on TLM in 10 studies. There was no statistically significant difference [SMD - 0.10 (95% Confidence Interval - 0.26 - 0.06; tau2 = 0). Heterogeneity across studies was null, and the 95% confidence interval (index of precision) was equal to the 95% predictive interval. The first systematic literature review showed that bDMARDs have a significant improve effect in nearly half of RA and SpA patients on muscle mass and muscle strength, assessed separately. However, the meta-analysis concluded that bDMARDs have no significant effect on TLM.
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Barnes A, Spizzo P, Bampton P, Andrews JM, Fraser RJ, Mukherjee S, Mountifield R. Examining the influence of inflammatory bowel disease medications on sleep quality. JGH OPEN 2023; 7:190-196. [PMID: 36968569 PMCID: PMC10037038 DOI: 10.1002/jgh3.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/25/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
Background and Aim Inflammatory bowel disease (IBD) can disrupt sleep, leading to poor sleep quality. This may in part be due to the symptoms of IBD and the influence of pro-inflammatory cytokines on sleep. This study aimed to investigate the potential influence of IBD medications on sleep quality. Methods An online survey of adults with IBD was conducted, which included measures of sleep quality, IBD activity, anxiety, depression, and physical activity. Logistic regression was used to investigate possible associations between IBD medications (corticosteroids, immunomodulators, biologics, aminosalicyate) and outcome of poor sleep. A generalized linear model was built for outcome of sleep quality score. Results There were 544 participants included in the final analysis, median age of 42, and 61% with Crohn's disease. Increased odds of poor sleep were seen in those taking opioids, medications for anxiety or depression, corticosteroids, vitamin D, methotrexate, and infliximab. A multivariate model was built incorporating demographic and IBD variables with opioids present in the final model and associated with increased odds of poor sleep. This was in addition to medications for sleep, depression, anxiety, IBD activity, and body weight. In a multivariate generalized linear model, opioids and methotrexate were associated with worse sleep quality scores. Conclusions Opioids were associated with increased odds of poor sleep independent of other factors. This provides further support for avoiding these medications in people with IBD. Infliximab was associated with increased body weight and consequently increased odds of poor sleep.
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Affiliation(s)
- Alex Barnes
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
| | - Paul Spizzo
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
| | - Peter Bampton
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
| | - Jane M Andrews
- Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology (CAHLN) Royal Adelaide Hospital Adelaide South Australia Australia
- School of Medicine, Faculty of Health & Medical Sciences University of Adelaide Adelaide South Australia Australia
| | - Robert J Fraser
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
| | - Sutapa Mukherjee
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
- Department of Respiratory and Sleep Medicine Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
| | - Réme Mountifield
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
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Hasegawa E, Ito S, Kurosawa Y, Kobayashi D, Otani H, Abe A, Nakazono K, Murasawa A, Narita I, Ishikawa H. The Efficacy of Biological Disease-modifying Antirheumatic Drugs on Sarcopenia in Patients with Rheumatoid Arthritis. Intern Med 2023; 62:373-379. [PMID: 36725065 PMCID: PMC9970816 DOI: 10.2169/internalmedicine.9600-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective Sarcopenia is characterized by a loss of muscle mass and strength, which leads to frailty and mortality. Rheumatoid arthritis (RA) is considered to be a cause of sarcopenia. The present study assessed the effectiveness of biological disease-modifying antirheumatic drugs (bDMARDs) on sarcopenia. Methods This was a prospective cohort study including 48 patients [11 men, 37 women; 67.5 (57.0-74.8) years old] with RA who started bDMARDs in Niigata Rheumatic Center. We monitored the physical ability, nutritional status and body composition at the baseline, 6 months and 12 months. The physical activity was measured by the Health Assessment Questionnaire (HAQ) and 10-m walking test (10MWT). The nutritional status was assessed by the controlling nutrition status (CONUT) score. Results Among the 48 patients who started bDMARDs, 21 were classified as having sarcopenia. The physical activity and nutritional status were significantly ameliorated after 12 months of bDMARDs. The body composition analysis showed a significant increase in the body weight but no significant increase in the skeletal muscle mass index. The proportion of patients diagnosed with sarcopenia decreased significantly after 12 months of bDMARDs (43.8% vs. 27.1%, p=0.039). Among the 21 patients who were diagnosed with sarcopenia when starting bDMARDs, the skeletal muscle index was significantly increased after 12 months of bDMARDs. [5.22 (4.76-5.43) kg/m2 vs. 5.44 (4.84-5.77), p=0.039]. Conclusion Biologics may be useful in the treatment of sarcopenia through mechanisms such as improving the disease activity, physical activity and nutritional status.
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Affiliation(s)
- Eriko Hasegawa
- Department of Rheumatology, Niigata Rheumatic Center, Japan
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | - Yoichi Kurosawa
- Department of Rheumatology, Niigata Rheumatic Center, Japan
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Daisuke Kobayashi
- Department of Rheumatology, Niigata Rheumatic Center, Japan
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Hiroshi Otani
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | - Asami Abe
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | | | - Akira Murasawa
- Department of Rheumatology, Niigata Rheumatic Center, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
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Galley JC, Singh S, Awata WMC, Alves JV, Bruder-Nascimento T. Adipokines: Deciphering the cardiovascular signature of adipose tissue. Biochem Pharmacol 2022; 206:115324. [PMID: 36309078 PMCID: PMC10509780 DOI: 10.1016/j.bcp.2022.115324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/02/2022]
Abstract
Obesity and hypertension are intimately linked due to the various ways that the important cell types such as vascular smooth muscle cells (VSMC), endothelial cells (EC), immune cells, and adipocytes, communicate with one another to contribute to these two pathologies. Adipose tissue is a very dynamic organ comprised primarily of adipocytes, which are well known for their role in energy storage. More recently adipose tissue has been recognized as the largest endocrine organ because of its ability to produce a vast number of signaling molecules called adipokines. These signaling molecules stimulate specific types of cells or tissues with many adipokines acting as indicators of adipocyte healthy function, such as adiponectin, omentin, and FGF21, which show anti-inflammatory or cardioprotective effects, acting as regulators of healthy physiological function. Others, like visfatin, chemerin, resistin, and leptin are often altered during pathophysiological circumstances like obesity and lipodystrophy, demonstrating negative cardiovascular outcomes when produced in excess. This review aims to explore the role of adipocytes and their derived products as well as the impacts of these adipokines on blood pressure regulation and cardiovascular homeostasis.
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Affiliation(s)
- Joseph C. Galley
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Pediatrics Research in Obesity and Metabolism (CPROM), University of Pittsburgh, Pittsburgh, PA, USA
| | - Shubhnita Singh
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Pediatrics Research in Obesity and Metabolism (CPROM), University of Pittsburgh, Pittsburgh, PA, USA
| | - Wanessa M. C. Awata
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Pediatrics Research in Obesity and Metabolism (CPROM), University of Pittsburgh, Pittsburgh, PA, USA
| | - Juliano V. Alves
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Pediatrics Research in Obesity and Metabolism (CPROM), University of Pittsburgh, Pittsburgh, PA, USA
| | - Thiago Bruder-Nascimento
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Pediatrics Research in Obesity and Metabolism (CPROM), University of Pittsburgh, Pittsburgh, PA, USA
- Endocrinology Division at UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
- Vascular Medicine Institute (VMI), University of Pittsburgh, Pittsburgh, PA, USA
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Hein TR, Peterson L, Bartikoski BJ, Portes J, Espírito Santo RC, Xavier RM. The effect of disease-modifying anti-rheumatic drugs on skeletal muscle mass in rheumatoid arthritis patients: a systematic review with meta-analysis. Arthritis Res Ther 2022; 24:171. [PMID: 35854372 PMCID: PMC9295282 DOI: 10.1186/s13075-022-02858-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/30/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is an autoimmune disease, characterized by chronic and systemic inflammation. Besides, it is known that RA patients may present several comorbidities, such as sarcopenia, a condition where patients present both muscle mass and muscle quality impairment. RA treatment is mostly pharmacological and consists in controlling systemic inflammation and disease activity. Despite that, the effect of pharmacological treatment on sarcopenia is not well characterized. OBJECTIVE To summarize the effects of disease-modifying anti-rheumatic drugs (DMARDs) on skeletal muscle tissue in rheumatoid arthritis (RA) patients. METHODS A systematic review of randomized clinical trials and observational studies was conducted using MEDLINE, Embase, Cochrane Library, and Web of Science. We selected studies with rheumatoid arthritis patients treated with disease-modifying anti-rheumatic drugs (DMARDs) that analyzed muscle mass parameters such as lean mass and appendicular lean mass. Methodological quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Standardized mean difference (SMD) and 95% confidence intervals (CI) were set. A meta-analysis of observational studies was performed using the R software, and we considered significant statistics when p < 0.05. RESULTS Nine studies were included in this systematic review. In the meta-analysis, DMARD treatment had no positive difference (p = 0.60) in lean mass. In the same way, in the appendicular lean mass parameter, our results showed that DMARDs did not have changes between baseline and post-treatment analysis (p = 0.93). CONCLUSION There is no evidence of a significant effect of DMARD therapy, either synthetic or biological, on muscle mass. However, this association should be investigated with more studies.
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Affiliation(s)
- Thales R Hein
- Universidade Federal do Rio Grande do Sul, Rheumatology, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil.
| | - Leonardo Peterson
- Universidade Federal do Rio Grande do Sul, Rheumatology, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil
| | - Barbara J Bartikoski
- Universidade Federal do Rio Grande do Sul, Rheumatology, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil
| | - Juliana Portes
- Universidade Federal do Rio Grande do Sul, Rheumatology, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil
| | - Rafaela C Espírito Santo
- Universidade Federal do Rio Grande do Sul, Rheumatology, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil
| | - Ricardo M Xavier
- Universidade Federal do Rio Grande do Sul, Rheumatology, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil
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Zhang M, Xu S, Zong H, Wang J, Chu Y, Cai J, Chang L. Effect of sarcopenia and poor balance on vertebral spinal osteoporotic fracture in female rheumatoid arthritis. Sci Rep 2022; 12:9477. [PMID: 35676311 PMCID: PMC9177606 DOI: 10.1038/s41598-022-13339-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 05/23/2022] [Indexed: 11/09/2022] Open
Abstract
This study investigated the effect of poor balance and sarcopenia on vertebral spinal osteoporotic fracture (VOPF) in female rheumatoid arthritic (RA) patients. A total of 195 female RA and 126 normal subjects were enrolled, and the correlations between sarcopenia, poor balance and VOPF were analyzed. Furthermore, we explored the relationships between sarcopenia or poor balance with disease related indexes of female RA. Binary logistic regression analyses were performed to identify potential risk factors for VOPF in female RA. We found that female RA had an increased risk of sarcopenia, poor balance (Berg balance scale, BBS ≤ 40) and VOPF than controls (P < 0.0001). Female RA with VOPF were more likely to have poor balance and sarcopenia than those without VOPF (P < 0.0001-0.05). Meanwhile, female RA with sarcopenia and poor balance often had higher disease activity, more serious joint damage and worse joint function (P < 0.05) compared with those without sarcopenia and poor balance. Binary logistic regression analysis (LR backwald) revealed that age (OR = 1.112, 95% CI 1.065-1.160, P < 0.0001), OP (OR = 10.137, 95% CI 4.224-24.330, P < 0.0001) and GCs usage (OR = 3.532, 95% CI 1.427-8.741, P = 0.006) were risk factors, while SMI (OR = 0.386, 95% CI 0.243-0.614, P < 0.0001) and BBS (OR = 0.952, 95% CI 0.929-0.976, P < 0.0001) were protective factors for VOPF in female RA. Hence, sarcopenia and poor balance are associated with a higher risk for VOPF and are closely related to disease activity and joint structure damage of female RA.
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Affiliation(s)
- Mei Zhang
- Department of Rheumatology and Nephrology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, 230000, China
| | - Shengqian Xu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
| | - Hexiang Zong
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Jianxiong Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Yiran Chu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Jingyu Cai
- Department of Rheumatology and Nephrology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, 230000, China
| | - Ling Chang
- Department of Rheumatology and Nephrology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, 230000, China
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de Souza MPGU, Guimarães NS, de Resende Guimarães MFB, de Souza VA, Kakehasi AM. Effect of biological disease-modifying antirheumatic drugs on body composition in patients with rheumatoid arthritis: a systematic review and meta-analysis. Adv Rheumatol 2022; 62:16. [DOI: 10.1186/s42358-022-00249-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/17/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Rheumatoid arthritis (RA) generates an inflammatory profile that predisposes to total and visceral fatty accumulation and reduced fat free mass (FFM). This metabolic disorder contributes to poor functionality, increased cardiovascular risk and higher mortality. This study aimed to address a systematic review with meta-analysis to determine the effect of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) on body composition (BC) of patients with RA.
Methods
The search was conducted at the electronic databases PubMed, Cochrane Library, Embase, Lilacs and grey literature. This investigation was carried until July 2021. Outcomes of interest were total weight, body mass index (BMI), fat mass (FM) and FFM. A meta-analysis comparing these outcomes in RA patients under bDMARD treatment versus controls was performed.
Results
Out of 137 studies reviewed, 18 were selected: fifteen prospective cohorts, two retrospective cohorts, and one cross-sectional study. The studies comprised 1221 patients, 778 on bDMARD treatment and 443 controls, which included RA patients under conventional synthetic DMARD (csDMARD). No study addressing BC analysis in patients using tsDMARD was found. The mean age and duration of the disease was 56.7 years and 6.77 years, respectively. Ten studies demonstrated a significant increase of total weight in 88.2% of patients and 42.3% for BMI. In studies that analyzed BC by double X-ray absorptiometry (DXA), the increase in total weight and BMI correlated positively to the increase in FFM. The meta-analysis carried out in five studies showed no significant difference of the mean difference for total weight 0.12 kg (95% CI − 5.58, 5.82), BMI 0.08 kg/m2 (95% CI − 1.76, 1.92), FM − 0.08 kg (95% IC − 5.31, 5.14), and FFM − 2.08 kg (95% CI − 7.37, 3.21).
Conclusion
This systematic review suggests a possible impact of bDMARDs on BC of RA patients, even though, the meta-analysis carried out in a small part of these studies was not able to confirm significant variation in BC components.
Trial registration: PROSPERO code: CRD42020206949.
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10
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Mendoza-Vázquez G, Espinoza-Gómez F, Rocha-Muñoz AD, Gamez-Nava JI, Gonzalez-Lopez L, Salazar-Paramo M, Riebeling-Navarro C, Aceves-Aceves JA, Guzmán-Silahua S, Nava-Zavala AH. Correlation between percentage of fat mass and level of disease activity in rheumatoid arthritis. SAGE Open Med 2022; 10:20503121221085821. [PMID: 35342627 PMCID: PMC8943587 DOI: 10.1177/20503121221085821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Controversies exist regarding the relationship between body fat and disease
activity in patients with rheumatoid arthritis. The evaluation of the
disease is critical for establishing treatment and prognosis. Fat mass could
be a predictive factor for poor prognosis in rheumatoid arthritis because of
its association with low- and high-grade inflammation. Objective: To evaluate the correlation between fat mass values and disease activity in
patients with rheumatoid arthritis. Materials and methods: This was a cross-sectional study. Eighty female patients diagnosed with
rheumatoid arthritis (American College of Rheumatology of 1987) were
evaluated. For each one, the evaluation determined fat mass using
bioelectrical impedance analysis and disease activity using the Disease
Activity Score on 28 joints (DAS28). Results: The mean age was 59.11 ± 9.92 years, with an average disease duration of
14.13 ± 10.13 years; 85% of patients showed a high body fat percentage.
Pearson’s correlation between DAS28 values and fat mass was
r = 0.035 (p = 0.76). Conclusion: The levels of DAS28 showed no correlation with fat mass percentage. Further
studies are required to clarify the factors that can modify these
levels.
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Affiliation(s)
- Guadalupe Mendoza-Vázquez
- Unidad de Investigación Epidemiologica y en Servicios de Salud y Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, OOAD Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.,Programa de Doctorado en Ciencias Médicas, Facultad de Medicina, Universidad de Colima, Colima, México
| | - Francisco Espinoza-Gómez
- Programa de Doctorado en Ciencias Médicas, Facultad de Medicina, Universidad de Colima, Colima, México
| | | | - Jorge I Gamez-Nava
- Unidad de Investigación Epidemiologica y en Servicios de Salud y Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, OOAD Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.,Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Laura Gonzalez-Lopez
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Mario Salazar-Paramo
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Carlos Riebeling-Navarro
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.,Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Javier Alejandro Aceves-Aceves
- Unidad de Investigación Epidemiologica y en Servicios de Salud y Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, OOAD Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.,Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Sandra Guzmán-Silahua
- Unidad de Investigación Epidemiologica y en Servicios de Salud y Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, OOAD Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.,Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Arnulfo Hernán Nava-Zavala
- Unidad de Investigación Epidemiologica y en Servicios de Salud y Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, OOAD Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.,Programa Internacional, Facultad de Medicina, Universidad Autónoma de Guadalajara, Zapopan, México.,Departamento de Inmunología y Reumatología, Hospital General de Occidente, Secretaría de Salud Jalisco, Zapopan, México
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11
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Hanaoka BY, Zhao J, Heitman K, Khan F, Jarjour W, Volek J, Brock G, Gower BA. Interaction effect of systemic inflammation and modifiable rheumatoid cachexia risk factors on resting energy expenditure in patients with rheumatoid arthritis. JCSM CLINICAL REPORTS 2022; 7:12-23. [PMID: 38288252 PMCID: PMC10824535 DOI: 10.1002/crt2.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/13/2021] [Indexed: 12/14/2022] Open
Abstract
Background In rheumatoid cachexia (RC), high resting energy expenditure (REE) is associated with loss of muscle mass driven by proinflammatory cytokines. The objectives of this study were to investigate parameters associated with RC, and the interaction between systemic inflammation and modifiable risk factors for RC on REE. Methods Thirty-five rheumatoid arthritis (RA) and nineteen non-RA controls comparable in age, sex, race and BMI underwent measures of REE by indirect calorimetry. Clinical, dietary, body composition and physical function data were collected. Homeostasis model assessment for insulin resistance (HOMA-IR) and serum interleukin-6 (IL-6) were used as parameters of IR and systemic inflammation, respectively. Regression models tested association between REE and dependent variables, including pre-specified interaction tests involving HOMA-IR and IL-6 and dietary intake of protein per weight (PPW) and IL-6. Results RA subjects were mostly women (94%) and had a median age of 54 years (50.5, 70) and BMI of 30.5 kg/m2 (26.1, 36.9). We observed a significant interaction effect between PPW and serum IL-6 on REE among RA subjects in the multiple regression model among RA. The upper tertile of PPW demonstrated a significant negative correlation between REE and IL-6 (β=-19.97, 95% CI [-35.41, -4.54], p=0.01). The lower tertile of PPW demonstrated a significant positive correlation between REE and IL-6 (β=42.24, 95% CI [4.25, 80.23], p=0.03). Conclusions While IR can lead to muscle catabolism, IR was not significantly associated with REE in RA individuals. Higher dietary protein intake could attenuate the effect of systemic inflammation on REE in RA patients.
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Affiliation(s)
- Beatriz Y Hanaoka
- Division of Rheumatology-Immunology, McCampbell Hall, 1581 Dodd Drive, Room 505, Columbus, OH, 43210
| | - Jing Zhao
- Division of Rheumatology-Immunology, McCampbell Hall, 1581 Dodd Drive, Room 505, Columbus, OH, 43210
| | - Kristen Heitman
- Division of Rheumatology-Immunology, McCampbell Hall, 1581 Dodd Drive, Room 505, Columbus, OH, 43210
| | - Fahad Khan
- Division of Rheumatology-Immunology, McCampbell Hall, 1581 Dodd Drive, Room 505, Columbus, OH, 43210
| | - Wael Jarjour
- Division of Rheumatology-Immunology, McCampbell Hall, 1581 Dodd Drive, Room 505, Columbus, OH, 43210
| | - Jeff Volek
- Division of Rheumatology-Immunology, McCampbell Hall, 1581 Dodd Drive, Room 505, Columbus, OH, 43210
| | - Guy Brock
- Division of Rheumatology-Immunology, McCampbell Hall, 1581 Dodd Drive, Room 505, Columbus, OH, 43210
| | - Barbara A Gower
- Division of Rheumatology-Immunology, McCampbell Hall, 1581 Dodd Drive, Room 505, Columbus, OH, 43210
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12
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Seo E, Shin YK, Hsieh YS, Lee JM, Seol GH. Linalyl acetate as a potential preventive agent against muscle wasting in rheumatoid arthritis rats chronically exposed to nicotine. J Pharmacol Sci 2021; 147:27-32. [PMID: 34294369 DOI: 10.1016/j.jphs.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/25/2021] [Accepted: 05/07/2021] [Indexed: 12/24/2022] Open
Abstract
Cigarette smoking has detrimental effects on rheumatoid arthritis (RA), characterized by muscle wasting. Linalyl acetate (LA), the main component of Lavandula angustifolia Mill (lavender) oil, has anti-inflammatory properties. We investigated the detrimental effects of chronic nicotine exposure in rats with RA, as well as the abilities of lavender oil and LA to prevent muscle wasting. Rats with RA induced by type II collagen were exposed to nicotine for 22 days from day 1. Lavender oil or LA was administered twice a week during the experiment. Compared with control, collagen-induced arthritis (CIA) and chronic nicotine exposure plus CIA (NicoCIA) showed increases in hind paw thickness and serum interleukin (IL)-6 and decreases in body weight and serum insulin-like growth factor (IGF)-1 levels. Moreover, weight and fiber cross-sectional area of the gastrocnemius muscle were much lower, and mitochondrial membrane potential of the gastrocnemius muscle was higher, in the NicoCIA than in the CIA. These alterations in the NicoCIA were prevented by lavender oil and LA. Importantly, LA showed greater activity than lavender oil in preventing IGF-1 reduction in the NicoCIA. These findings suggest that lavender oil and LA may have preventive benefit in RA by counteracting muscle wasting associated with chronic nicotine exposure.
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Affiliation(s)
- Eunhye Seo
- Department of Basic Nursing Science, College of Nursing, Korea University, Seoul, Republic of Korea
| | - You Kyoung Shin
- Department of Basic Nursing Science, College of Nursing, Korea University, Seoul, Republic of Korea
| | - Yu Shan Hsieh
- Department of Basic Nursing Science, College of Nursing, Korea University, Seoul, Republic of Korea; School of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Jeong-Min Lee
- KT&G Central Research Institute, Daejeon, Republic of Korea
| | - Geun Hee Seol
- Department of Basic Nursing Science, College of Nursing, Korea University, Seoul, Republic of Korea; BK21 FOUR Program of Transdisciplinary Major in Learning Health Systems, Graduate School, Korea University, Seoul, Republic of Korea.
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13
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Seoane-Collazo P, Rial-Pensado E, Estévez-Salguero Á, Milbank E, García-Caballero L, Ríos M, Liñares-Pose L, Scotece M, Gallego R, Fernández-Real JM, Nogueiras R, Diéguez C, Gualillo O, López M. Activation of hypothalamic AMPK ameliorates metabolic complications of experimental arthritis. Arthritis Rheumatol 2021; 74:212-222. [PMID: 34398520 DOI: 10.1002/art.41950] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/09/2021] [Accepted: 08/10/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate whether thermogenesis and the hypothalamus may be involved in the physiopathology of experimental arthritis (EA). METHODS EA was induced in Lewis male rats by intradermal injection of Freund's complete adjuvant (FCA). Food intake, body weight, plasma cytokines, thermographic analysis, gene and protein expression of thermogenic markers in brown (BAT) and white (WAT) adipose tissue and hypothalamic AMP-activated protein kinase (AMPK) were analyzed. Virogenetic activation of hypothalamic AMPK was performed. RESULTS We first demonstrate that EA is associated with increased BAT thermogenesis and browning of subcutaneous WAT (sWAT) leading to elevated energy expenditure. Moreover, rats suffering EA show inhibition of hypothalamic AMPK, a canonical energy sensor modulating energy homeostasis at central level. Notably, specific genetic activation of AMPK in the ventromedial nucleus of the hypothalamus (VMH; a key site modulating energy metabolism) reverses the effect of EA on energy balance, brown fat and browning, as well as promoting an amelioration of the inflammatory status. CONCLUSION Overall, these data indicate that EA promotes a central catabolic state that can be targeted and reversed by the activation of hypothalamic AMPK. This might open new therapeutic alternatives to treat rheumatoid arthritis (RA)-associated metabolic comorbidities, improving RA-patients overall prognosis.
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Affiliation(s)
- Patricia Seoane-Collazo
- Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria, and CIBERobn, Santiago de Compostela, Spain
| | - Eva Rial-Pensado
- Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria, and CIBERobn, Santiago de Compostela, Spain
| | - Ánxela Estévez-Salguero
- Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria, and CIBERobn, Santiago de Compostela, Spain
| | - Edward Milbank
- Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria, and CIBERobn, Santiago de Compostela, Spain
| | | | - Marcos Ríos
- Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria, and CIBERobn, Santiago de Compostela, Spain
| | - Laura Liñares-Pose
- Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria, and CIBERobn, Santiago de Compostela, Spain
| | - Morena Scotece
- SERGAS, Instituto de Investigación Sanitaria de Santiago, NEIRID Lab, and Santiago University Clinical Hospital, Santiago de Compostela, Spain
| | - Rosalía Gallego
- Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Manuel Fernández-Real
- CIBERobn, Santiago de Compostela, Spain, and Institut d'Investigació Biomèdica de Girona and Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Rubén Nogueiras
- Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria, and CIBERobn, Santiago de Compostela, Spain
| | - Carlos Diéguez
- Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria, and CIBERobn, Santiago de Compostela, Spain
| | - Oreste Gualillo
- SERGAS, Instituto de Investigación Sanitaria de Santiago, NEIRID Lab, and Santiago University Clinical Hospital, Santiago de Compostela, Spain
| | - Miguel López
- Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria, and CIBERobn, Santiago de Compostela, Spain
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14
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Sellam J, Morel J, Tournadre A, Bouhnik Y, Cornec D, Devauchelle-Pensec V, Dieudé P, Goupille P, Jullien D, Kluger N, Lazaro E, Le Goff B, de Lédinghen V, Lequerré T, Nocturne G, Seror R, Truchetet ME, Verhoeven F, Pham T, Richez C. PRACTICAL MANAGEMENT of patients on anti-TNF therapy: Practical guidelines drawn up by the Club Rhumatismes et Inflammation (CRI). Joint Bone Spine 2021; 88:105174. [PMID: 33992225 DOI: 10.1016/j.jbspin.2021.105174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jérémie Sellam
- Service de Rhumatologie, CHU Saint-Antoine, Paris, France
| | - Jacques Morel
- Service de Rhumatologie, CHU Montpellier, Montpellier, France
| | - Anne Tournadre
- Service de Rhumatologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Yoram Bouhnik
- Service de Gastro-entérologie, CHU Hôpital Beaujon, Clichy, France
| | - Divi Cornec
- Service de Rhumatologie, CHRU La Cavale Blanche, Brest, France
| | | | - Philippe Dieudé
- Service de Rhumatologie, CHU Bichat-Claude Bernard, Paris, France
| | | | | | - Nicolas Kluger
- Dpt Dermatology, Helsinki, Finland; Service de Dermatologie, CHU Bichat-Claude Bernard, Paris, France
| | - Estibaliz Lazaro
- Service de Médecine interne, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | - Victor de Lédinghen
- Unité d'Hépatologie et transplantation hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | | | - Raphaèle Seror
- Service de Rhumatologie, Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | - Thao Pham
- Service de Rhumatologie, CHU Sainte-Marguerite, Marseille, France
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15
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Letarouilly JG, Flipo RM, Cortet B, Tournadre A, Paccou J. Body composition in patients with rheumatoid arthritis: a narrative literature review. Ther Adv Musculoskelet Dis 2021; 13:1759720X211015006. [PMID: 34221129 PMCID: PMC8221676 DOI: 10.1177/1759720x211015006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/13/2021] [Indexed: 01/09/2023] Open
Abstract
There is growing interest in the alterations in body composition (BC) that accompany rheumatoid arthritis (RA). The purpose of this review is to (i) investigate how BC is currently measured in RA patients, (ii) describe alterations in body composition in RA patients and (iii) evaluate the effect on nutrition, physical training, and treatments; that is, corticosteroids and biologic Disease Modifying Anti-Rheumatic Disease (bDMARDs), on BC in RA patients. The primary-source literature for this review was acquired using PubMed, Scopus and Cochrane database searches for articles published up to March 2021. The Medical Subject Headings (MeSH) terms used were 'Arthritis, Rheumatoid', 'body composition', 'sarcopenia', 'obesity', 'cachexia', 'Absorptiometry, Photon' and 'Electric Impedance'. The titles and abstracts of all articles were reviewed for relevant subjects. Whole-BC measurements were usually performed using dual energy x-ray absorptiometry (DXA) to quantify lean- and fat-mass parameters. In RA patients, lean mass is lower and adiposity is higher than in healthy controls, both in men and women. The prevalence of abnormal BC conditions such as overfat, sarcopenia and sarcopenic obesity is significantly higher in RA patients than in healthy controls; these alterations in BC are observed even at an early stage of the disease. Data on the effect treatments on BC in RA patients are scarce. In the few studies published, (a) creatine supplementation and progressive resistance training induce a slight and temporary increase in lean mass, (b) exposure to corticosteroids induces a gain in fat mass and (c) tumour necrosis factor alpha (TNFα) inhibitors might be associated with a gain in fat mass, while tocilizumab might be associated with a gain in lean mass. The available data clearly demonstrate that alterations in BC occur in RA patients, but data on the effect of treatments, especially bDMARDs, are inconsistent and further studies are needed in this area.
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Affiliation(s)
- Jean-Guillaume Letarouilly
- University of Lille F-59000 Lille, CHU Lille F-59000 Lille, France; University of Littoral Côte d'Opale F-62200 Boulogne-sur-Mer, France; Marrow Adiposity and Bone Lab - MABLab ULR4490Lille, France
| | - René-Marc Flipo
- Department of Rheumatology, University of Lille, CHU Lille, F-59000 Lille, France
| | - Bernard Cortet
- University of Lille F-59000 Lille, CHU Lille F-59000 Lille, France; University of Littoral Côte d'Opale F-62200 Boulogne-sur-Mer, France; Marrow Adiposity and Bone Lab - MABLab ULR4490Lille, France
| | - Anne Tournadre
- University of Clermont Auvergne, CHU Clermont-Ferrand, UNH-UMR 1019, INRA Department of Rheumatology, F-63003 Clermont-Ferrand, France
| | - Julien Paccou
- MABlab ULR 4490, Department of Rheumatology, CHU Lille, 2, Avenue Oscar Lambret - 59037 Lille Cedex
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16
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Karpouzas GA, Bui VL, Ronda N, Hollan I, Ormseth SR. Biologics and atherosclerotic cardiovascular risk in rheumatoid arthritis: a review of evidence and mechanistic insights. Expert Rev Clin Immunol 2021; 17:355-374. [PMID: 33673792 DOI: 10.1080/1744666x.2021.1899809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Cardiovascular disease is a leading comorbidity in rheumatoid arthritis. Timely introduction of biologic therapies in a treat-to-target approach has optimized disease-related outcomes and attenuated accrual of comorbidities, including cardiovascular risk.Areas covered: A literature search in MEDLINE (via PubMed) was performed between January 2009 and November 2020. This manuscript explores recent developments in atherosclerotic cardiovascular risk in RA compared with non-RA individuals; it synopsizes differences in vascular function and inflammation, prevalence, burden, vulnerability, and progression of atherosclerotic plaque and their underlying cellular and molecular mechanisms. Finally, it reviews the recent literature on cardioprotective benefits of biologics and draws mechanistic links with inhibition of new plaque formation, stabilization of high-risk lesions and improvement in endothelial function, arterial stiffness, lipid metabolism, and traditional cardiac risk factors.Expert opinion: Increasing evidence points to a solid cardioprotective influence of earlier, longer, and ongoing use of biologic treatments in RA. Nevertheless, the precise mechanistic effects of plaque progression and remodeling, vascular stiffness, endothelial dysfunction, lipid metabolism, and traditional cardiac risk factors are less rigorously characterized.
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Affiliation(s)
- George A Karpouzas
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Viet L Bui
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nicoletta Ronda
- Department of Food and Drug, University of Parma, Parma, Italy
| | - Ivana Hollan
- The Norwegian University of Science and Technology, Gjøvik, Norway.,Beitostølen Sport and Health Centre, Beitostølen, Norway
| | - Sarah R Ormseth
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
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17
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Ajeganova S, Wörnert M, Hafström I. Team Rehabilitation in Inflammatory Arthritis Benefits Functional Outcomes Along With Improved Body Composition Associated With Improved Cardiorespiratory Fitness. J Rheumatol 2021; 48:1371-1378. [PMID: 33526616 DOI: 10.3899/jrheum.201301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We investigated the effect of team rehabilitation in inflammatory arthritis (IA) on body composition and physical function. Further, we examined whether body composition and physical function are associated with disability and cardiorespiratory fitness (CRF). METHODS The participants were 149 patients (74% women) with chronic arthritis, a mean age of 53 (SD 13) years, and mean disease duration of 21 (SD 13) years. They participated in a 4-week team rehabilitation program and were evaluated at prerehabilitation, and at 3 and 12 months postrehabilitation. Body composition was assessed by bioelectrical impedance analysis and CRF by the Åstrand 6-minute cycle test. ANCOVA with Bonferroni correction and linear mixed models were applied. RESULTS After 3 and 12 months, there were significant reductions in waist circumference and measures of fat, adjusted for age, sex, and baseline measures. The prevalence of adiposity and central obesity decreased after 12 months. Hand grip strength and timed sit-to-stand (TST) improved together with reduction in Health Assessment Questionnaire (HAQ) and increased VO2max after 3 and 12 months. HAQ reduction over time was associated with prerehabilitation measures of lean mass of legs, hand grip strength, TST, and physical activity, and changes in hand grip strength, physical activity, and sedentary time, but not with changes of body composition. VO2max improvement over time was associated with prerehabilitation BMI, waist circumference, measures of fat and lean mass, changes in BMI, waist circumference, and measures of fat. CONCLUSION In patients with IA, 4-week team rehabilitation benefited body composition, level of physical functioning, activity, and CRF for up to 12 months. Measures of physical function and activity were linked to HAQ over time, whereas body composition was linked to CRF.
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Affiliation(s)
- Sofia Ajeganova
- S. Ajeganova, MD, PhD, Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden, and Department of Clinical Sciences, Rheumatology Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium;
| | - Margareta Wörnert
- M. Wörnert, RN, Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Ingiäld Hafström
- I. Hafström, MD, PhD, Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, and Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
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18
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The Effect of TNF and Non-TNF-Targeted Biologics on Body Composition in Rheumatoid Arthritis. J Clin Med 2021; 10:jcm10030487. [PMID: 33573047 PMCID: PMC7866419 DOI: 10.3390/jcm10030487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 12/28/2022] Open
Abstract
Rheumatoid arthritis (RA) is associated with a decrease in lean mass and stability or even an increase in fat and ectopic adipose tissue. A few data are available on body composition changes under treatment, and data are still controversial. Body composition was assessed before initiation of biologic disease-modifying antirheumatic drug (bDMARD) and after 6 and 12 months of stable treatment. Eighty-three RA patients were included (75% of women, mean age 58.5 ± 10.8 years) of whom 47 patients treated with TNF inhibitor (TNFi), 18 with non-TNF-targeted biologic (Non-TNFi), and 18 with conventional DMARD (cDMARD) alone. In the TNFi group, total lean mass, fat-free mass index, and skeletal muscle mass index significantly increased at 1 year. An increase in subcutaneous adipose tissue (SAT) without change for the visceral or body fat composition was associated. These changes were associated with an improvement in strength and walking test. In non-TNFi or cDMARD groups, no significant changes for body composition or muscle function were observed at 1 year. However, no significant differences for treatment x time interaction were noted between group treatments. In active RA patients starting first bDMARD, treatment with TNFi over 1 year was associated with favorable changes of the body composition and muscle function.
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Atzeni F, Nucera V, Gerratana E, Fiorenza A, Gianturco L, Corda M, Sarzi-Puttini P. Cardiovascular Consequences of Autoimmune Rheumatic Diseases. Curr Vasc Pharmacol 2020; 18:566-579. [PMID: 31985379 DOI: 10.2174/1570161118666200127142936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/23/2019] [Accepted: 12/28/2019] [Indexed: 12/23/2022]
Abstract
The increased risk of cardiovascular disease (CVD) among patients with autoimmune rheumatic diseases such as rheumatoid arthritis, spondyloarthritis and systemic lupus erythematosus has been extensively documented. Sub-clinical atherosclerosis can be assessed using various non-invasive imaging techniques. However, the mechanisms underlying the higher risk of atherosclerotic CVD in patients with autoimmune rheumatic diseases are not fully known, although they seem to include chronic low-grade systemic inflammation leading to prolonged endothelial activation, accompanied by a pro-thrombotic/pro-coagulant and autoantibody state. Furthermore, sub-clinical atherosclerosis is also influenced by other traditional risk factors for CVD. Including the individual components of the metabolic syndrome (MetS: obesity, impaired glucose metabolism, dyslipidemia and high blood pressure), the degree of which is higher in these patients than in controls. The aim of this narrative review is to discuss the CV manifestations and risk factors involved in the increased risk of CVD among patients with autoimmune rheumatic diseases.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Italy
| | - Valeria Nucera
- Rheumatology Unit, University of Messina, Messina, Italy
| | | | | | - Luigi Gianturco
- Cardiology Unit, Beato Matteo Hospital, GSD Hospitals, Vigevano, Pavia, Italy
| | - Marco Corda
- Cardiology Unit, Brotzu Hospital, Cagliari, Italy
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Lepp J, Höög C, Forsell A, Fyrhake U, Lördal M, Almer S. Rapid weight gain in infliximab treated Crohn's disease patients is sustained over time: real-life data over 12 months. Scand J Gastroenterol 2020; 55:1411-1418. [PMID: 33108226 DOI: 10.1080/00365521.2020.1837929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Infliximab (IFX) is used in active Crohn's disease for induction and maintenance of remission. There are scanty data on weight gain in IBD-patients under anti-TNF treatment. We investigated changes in weight and blood chemistry in anti-TNF-naïve Crohn's disease patients during their first course of IFX. METHODS Retrospective analysis of 110 patients (77 men, 33 women) aged 34 years (range 14-73), 54 with luminal and 56 with fistulising disease, given at least 3 infusions of IFX (range 3-11). Data regarding body weight, height, C-reactive protein (CRP), haemoglobin and S-albumin at baseline, before the third infusion, at three months and at 12 months were collected. RESULTS At 6 weeks, 65 (59%) increased in weight, 73% and 76% at three and 12 months, respectively. There was an increase in median weight (1.7 kg, IQR = 3.1 kg) and BMI (0.5 kg/m2, IQR = 1.2 kg/m2) at 6 weeks, which persisted at three and 12 months (all p < .001). There was no difference between men and women. Young patients, patients with underweight or fistulising disease increased most in weight. Disease activity assessed by PGA and SES-CD decreased at all time points (p < .05). Increases in weight and BMI correlated with an increase in serum albumin and a decrease in CRP. CONCLUSION Approximately 60% of Crohn's disease patients experience weight gain within the first six weeks of infliximab treatment. The weight increment correlates with improvements in inflammatory markers and disease activity. The causes of weight gain may be related to treatment induced metabolic changes and reduced inflammatory burden.
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Affiliation(s)
- Johanna Lepp
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Charlotte Höög
- Department of Medicine, Karolinska Institutet, Huddinge, Sweden.,GHP Stockholm Gastro Center, Stockholm, Sweden
| | - Anette Forsell
- Department of Medicine, Ersta Hospital, Stockholm, Sweden
| | - Ulrika Fyrhake
- Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Lördal
- GI-unit, Department of Medicine, Danderyd Hospital, Danderyd, Sweden
| | - Sven Almer
- Department of Medicine, Karolinska Institutet, Solna, Sweden.,Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
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Ben Abdallah I, Ben Nasr S, Chourabi C, Boukhris M, Ben Abdallah I, Zribi A, Fendri S, Balti M, Fehri W, Chraiet N, Haddaoui A. The Predictive Value of 2D Myocardial Strain for Epirubicin-Induced Cardiotoxicity. JOURNAL OF ONCOLOGY 2020; 2020:5706561. [PMID: 33335549 PMCID: PMC7723482 DOI: 10.1155/2020/5706561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/06/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Although epirubicin has significantly improved outcome in breast cancer (BC) patients, it is responsible for myocardial dysfunction that affects patients' quality of life. The use of 2D global longitudinal strain (GLS) has been reported to detect early myocardial dysfunction. The aim of this study was to evaluate how GLS changes can predict cardiotoxicity. METHODS We conducted a prospective study from March 2018 to March 2020 on 66 patients with no cardiovascular risk factors, who presented with BC and received epirubicin. We measured left ventricular ejection fraction (LVEF) and GLS before chemotherapy, at three months (T3), and at 12 months (T12) from the last epirubicin infusion. Chemotherapy-Related-Cardiac-Dysfunction (CTRCD) was defined as a decrease of 10% in LVEF to a value below 53% according to ASE and EACI 2014 expert consensus. RESULTS The mean age at diagnosis was 47 ± 9 years old. At baseline, median LVEF was 70% and median GLS was -21%. Shortly after chemotherapy completion, two patients presented with symptomatic heart failure while asymptomatic CTRCD was revealed in three other patients at T12. Three months after the last epirubicin infusion, median LVEF was 65%, median GLS was -19%, and median GLS variation was 5%. However, in patients who presented with subsequent CTRCD, median GLS at T3 was -16% and median GLS variation was 19% (p=0.002 and p < 0.001, respectively, when compared to patients who did not develop cardiotoxicity). Persistent GLS decrease at T3 was an independent predictor of CTRCD at T12. Age and left-sided thoracic irradiation did not increase the risk of cardiotoxicity in our study while the cumulative dose of epirubicin significantly affected cardiologic findings (p=0.001). CONCLUSION This was the first North African study that assesses the value of measuring GLS to early detect cardiotoxicity. Patients whose GLS remained decreased after 3 months from anthracyclines-base chemotherapy had an increased risk for developing subsequent CTRCD. Further studies with larger sample size are warranted to identify the best cardioprotective molecules to be initiated in these patients before LVEF declines.
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Affiliation(s)
- Ichrak Ben Abdallah
- Department of Medical Oncology, Military Hospital of Tunis, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis 1007, Tunisia
| | - Sonia Ben Nasr
- Department of Medical Oncology, Military Hospital of Tunis, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis 1007, Tunisia
| | - Chadia Chourabi
- Department of Cardiology, Military Hospital of Tunis Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis 1007, Tunisia
| | - Marouane Boukhris
- Division of Cardiology, Centre Hospitalier de l'université de Montréal, Montreal, Québec, Canada
| | - Israa Ben Abdallah
- Department of Business Analytics, Tunis Business School, El Mourouj, Tunisia
| | - Aref Zribi
- Department of Medical Oncology, Military Hospital of Tunis, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis 1007, Tunisia
| | - Sana Fendri
- Department of Medical Oncology, Military Hospital of Tunis, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis 1007, Tunisia
| | - Mehdi Balti
- Department of Medical Oncology, Military Hospital of Tunis, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis 1007, Tunisia
| | - Wafa Fehri
- Department of Cardiology, Military Hospital of Tunis Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis 1007, Tunisia
| | - Nesrine Chraiet
- Department of Medical Oncology, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis 1007, Tunisia
| | - Abderrazek Haddaoui
- Department of Medical Oncology, Military Hospital of Tunis, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis 1007, Tunisia
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Patsalos O, Dalton B, Leppanen J, Ibrahim MAA, Himmerich H. Impact of TNF-α Inhibitors on Body Weight and BMI: A Systematic Review and Meta-Analysis. Front Pharmacol 2020; 11:481. [PMID: 32351392 PMCID: PMC7174757 DOI: 10.3389/fphar.2020.00481] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/27/2020] [Indexed: 12/12/2022] Open
Abstract
Objective The aim of this systematic review and meta-analysis of longitudinal studies was to ascertain to effects of TNF-α inhibitor therapy on body weight and BMI. Methods Three databases (PubMed, OVID, and EMBASE) were systematically searched from inception to August 2018. We identified prospective, retrospective, and randomized controlled studies in adults with immune-mediated inflammatory diseases treated with TNF-α inhibitors based on pre-specified inclusion criteria. A random-effects model was used to estimate standardised mean change (SMCC). Results Twenty-six longitudinal studies with a total of 1,245 participants were included in the meta-analysis. We found evidence for a small increase in body weight (SMCC = 0.24, p = .0006, 95% CI [0.10, 0.37]) and in BMI (SMCC = 0.26, p < .0001, 95% CI [0.13, 0.39]). On average, patients gained 0.90kg (SD = 5.13) under infliximab, 2.34kg (D = 5.65) under etanercept and 2.27kg (SD = 4.69) during treatment with adalimumab within the duration of the respective studies (4–104 weeks). Conclusion Our results yield further support the for the view that TNF-α inhibitors increase body weight and BMI as a potential side effect. Modulating cytokine signaling could be a future therapeutic mechanism to treat disorders associated with weight changes such as anorexia nervosa.
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Affiliation(s)
- Olivia Patsalos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Bethan Dalton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jenni Leppanen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Mohammad A A Ibrahim
- Department of Clinical Immunological Medicine and Allergy, King's Health Partners, King's College Hospital, London, United Kingdom
| | - Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Abstract
Based on current knowledge deriving from studies in animals and humans (the general population and patients with non-communicable diseases), there is biological plausibility that exercise may have anti-inflammatory effects. This may be particularly important for patients with chronic inflammatory rheumatic and musculoskeletal diseases (RMDs). The present review discusses the current state-of-the-art on exercise and inflammation, explores how exercise can moderate inflammation-dependent RMD outcomes and the most prevalent systemic manifestations and addresses the relationship between the dosage (particularly the intensity) of exercise and inflammation. We conclude that present data support potential beneficial effects of exercise on inflammation, however, the evidence specifically in RMDs is limited and inconclusive. More targeted research is required to elucidate the effects of exercise on inflammation in the context of RMDs.
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Affiliation(s)
- George S Metsios
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK; Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK; School of Physical Education and Sport Science, University of Thessaly, Greece.
| | - Rikke H Moe
- National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - George D Kitas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Toussirot E. The Interrelations between Biological and Targeted Synthetic Agents Used in Inflammatory Joint Diseases, and Obesity or Body Composition. Metabolites 2020; 10:E107. [PMID: 32183053 PMCID: PMC7175105 DOI: 10.3390/metabo10030107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 12/16/2022] Open
Abstract
Obesity is a comorbidity that plays a role in the development and severity of inflammatory joint diseases, including rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. The relationships between obesity and adipose tissue and the treatments given for inflammatory joint diseases are bidirectional. In fact, biological agents (bDMARDs) and targeted synthetic agents (tsDMARDs) may influence body weight and body composition of treated patients, while obesity in turn may influence clinical response to these agents. Obesity is a prevalent comorbidity mainly affecting patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) with specific phenotypes. Tumour necrosis factor alpha (TNFα) inhibitors have been associated with changes in body composition by improving lean mass, but also by significantly increasing fat mass, which localized toward the abdominal/visceral region. The IL-6 inhibitor tocilizumab is associated with an increase in lean mass without change in fat mass. The clinical response to TNFα inhibitors is attenuated by obesity, an effect that is less pronounced with IL-6 inhibitors and the B-cell depletion agent rituximab. Conversely, body weight has no influence on the response to the costimulation inhibitor abatacept. These effects may be of help to the physician in personalized medicine, and may guide the therapeutic choice in obese/overweight patients.
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Affiliation(s)
- Eric Toussirot
- INSERM CIC-1431, CHU de Besançon, Centre d’Investigation Clinique Biothérapie, Pôle Recherche, 25000 Besançon, France; ; Tel.: +33-3-81-21-89-97
- Fédération Hospitalo-Universitaire INCREASE, CHU de Besançon, 25000 Besançon, France
- CHU de Besançon, Rhumatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), 25000 Besançon, France
- Département Universitaire de Thérapeutique, Université de Bourgogne Franche-Comté, UFR des Sciences Médicales et Pharmaceutiques de Besançon, CS 71806, 25030 Besançon Cedex, France
- INSERM UMR1098, Relations Hôte Greffon Tumeurs, ingénierie cellulaire et génique, Université de Bourgogne Franche-Comté, 25000 Besançon, France
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Aryaeian N, Sedehi SK, Khorshidi M, Zarezadeh M, Hosseini A, Shahram F. Effects of hydroalcoholic extract of Berberis Integerrima on the anthropometric indices and metabolic profile in active rheumatoid arthritis patients. Complement Ther Med 2020; 50:102331. [PMID: 32444035 DOI: 10.1016/j.ctim.2020.102331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/16/2020] [Accepted: 01/27/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Since, the main cause of death in Rheumatoid arthritis (RA) patients is the presence of type 2 diabetes, abnormal increase in blood lipids, blood pressure and obesity, the aim of this study was to assess the effects of Barberry on the anthropometric indices and metabolic profile in patients with RA. DESIGN present study was a double-blinded, placebo-controlled randomized clinical trial. SETTING 70 active RA patients were randomly allocated into intervention or placebo group INTERVENTION: Participants received 6 capsules of 500 mg barberry extract or placebo for 3 months. MAIN OUTCOME MEASURES Serum levels of fasting blood sugar (FBS), triglyceride (TG), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C), systolic and diastolic blood pressure and anthropometric factors were assessed at baseline and at the end of the trial. RESULTS The results of intervention on 62 patients showed that weight, BMI, and conicity index increased in both groups, but this was significant only in the placebo group (p < 0.001). Waist and hip circumference were decreased in the intervention group and increased significantly in the placebo group (p < 0.001). Body fat percent (p = 0.04), LDL-C (p = 0.05) and SBP (p = 0.02) significantly were decreased in the intervention group. The results showed a significant decrease in body fat percent (p = 0.05), hip circumference (p < 0.001), FBS (p = 0.03) and HDL-C (p = 0.03) in the intervention group compared to the placebo. CONCLUSIONS Overall, the results of this study demonstrated that the extract of Berberis Integerrima had beneficial effects on metabolic profile and anthropometric indices in RA patients.
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Affiliation(s)
- Naheed Aryaeian
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Sara Khorshidi Sedehi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Masoud Khorshidi
- Student Research Committee, Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Mofid Children's Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Meysam Zarezadeh
- Department of Clinical Nutrition, Student Research Committee, Nutrition Research Center, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - AghaFatemeh Hosseini
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Farhad Shahram
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Metsios GS, Kitas GD. Should patients with rheumatic diseases take pain medication in order to engage in exercise? Expert Rev Clin Immunol 2020; 16:235-237. [PMID: 31928254 DOI: 10.1080/1744666x.2020.1714438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- George S Metsios
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK.,School of Physical Education and Sport Science, University of Thessaly, Volos, Greece
| | - George D Kitas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Rodin I, Chan J, Meleady L, Hii C, Lawrence S, Jacobson K. High body mass index is not associated with increased treatment failure in infliximab treated pediatric patients with inflammatory bowel disease. JGH OPEN 2019; 4:446-453. [PMID: 32514452 PMCID: PMC7273726 DOI: 10.1002/jgh3.12277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 12/18/2022]
Abstract
Background and Aim While weight gain during infliximab therapy in inflammatory bowel disease (IBD) is common, there has been limited research evaluating its impact on infliximab efficacy. Methods Primary aims of this study were to determine the frequency of excess weight gain (body mass index [BMI] > 25 kg/m2) in children with IBD on maintenance infliximab and evaluate the impact on infliximab dosing, serum trough levels, and treatment failure. Secondary aims were to determine differences in weight gain, treatment characteristics, and clinical/biochemical variables between patients with therapeutic and subtherapeutic maintenance therapy trough levels. We performed a retrospective study of 253 pediatric IBD (75.1% Crohn's disease, 23.3% ulcerative colitis, 1.6% IBD-unclassified) patients on infliximab followed at BC Children's Hospital between January 2013 and January 2018. Results Median age at infliximab initiation was 13.9 years, median length of follow up was 56.9 months, and 55.7% were males; 10.3% of the cohort demonstrated excess weight gain (7.5% overweight, 2.8% obese). Average mg/kg dosing was not statistically different between groups (normal, overweight, and obese: 6.7, 6.4, and 6.7 mg/kg, respectively, P = 0.52). Median BMI of patients with therapeutic and subtherapeutic trough levels was similar at 19.9 kg/m2 (interquartile range [IQR], 17.3-23.8) and 19.7 kg/m2 (IQR, 17.4-21.9), respectively. BMI had no effect on secondary loss of response to infliximab, with no significant difference between normal and high BMI subgroups (13.4 vs. 16.7%, P = 0.9). Conclusions In a subgroup of pediatric IBD patients on maintenance infliximab, excess weight gain was not associated with higher weight-based dosing, lower serum trough levels, or increased risk of treatment failure.
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Affiliation(s)
- Isaac Rodin
- MD Undergraduate Program University of British Columbia Vancouver Canada
| | - Justin Chan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine University of British Columbia Vancouver Canada.,British Columbia Children Hospital Research Institute, University of British Columbia Vancouver Canada
| | - Laura Meleady
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine University of British Columbia Vancouver Canada.,British Columbia Children Hospital Research Institute, University of British Columbia Vancouver Canada
| | - Clare Hii
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine University of British Columbia Vancouver Canada.,British Columbia Children Hospital Research Institute, University of British Columbia Vancouver Canada
| | - Sally Lawrence
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine University of British Columbia Vancouver Canada.,British Columbia Children Hospital Research Institute, University of British Columbia Vancouver Canada
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine University of British Columbia Vancouver Canada.,British Columbia Children Hospital Research Institute, University of British Columbia Vancouver Canada.,Department of Cellular and Physiological Sciences University of British Columbia Vancouver Canada
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MicroRNA-29a Exhibited Pro-Angiogenic and Anti-Fibrotic Features to Intensify Human Umbilical Cord Mesenchymal Stem Cells-Renovated Perfusion Recovery and Preventing against Fibrosis from Skeletal Muscle Ischemic Injury. Int J Mol Sci 2019; 20:ijms20235859. [PMID: 31766662 PMCID: PMC6928887 DOI: 10.3390/ijms20235859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022] Open
Abstract
This study was conducted to elucidate whether microRNA-29a (miR-29a) and/or together with transplantation of mesenchymal stem cells isolated from umbilical cord Wharton’s jelly (uMSCs) could aid in skeletal muscle healing and putative molecular mechanisms. We established a skeletal muscle ischemic injury model by injection of a myotoxin bupivacaine (BPVC) into gastrocnemius muscle of C57BL/6 mice. Throughout the angiogenic and fibrotic phases of muscle healing, miR-29a was considerably downregulated in BPVC-injured gastrocnemius muscle. Overexpressed miR-29a efficaciously promoted human umbilical vein endothelial cells proliferation and capillary-like tube formation in vitro, crucial steps for neoangiogenesis, whereas knockdown of miR-29a notably suppressed those endothelial functions. Remarkably, overexpressed miR-29a profitably elicited limbic flow perfusion and estimated by Laser Dopple. MicroRNA-29a motivated perfusion recovery through abolishing the tissue inhibitor of metalloproteinase (TIMP)-2, led great numbers of pro-angiogenic matrix metalloproteinases (MMPs) to be liberated from bondage of TIMP, thus reinforced vascular development. Furthermore, engrafted uMSCs also illustrated comparable effect to restore the flow perfusion and augmented vascular endothelial growth factors-A, -B, and -C expression. Notably, the combination of miR29a and the uMSCs treatments revealed the utmost renovation of limbic flow perfusion. Amplified miR-29a also adequately diminished the collagen deposition and suppressed broad-wide miR-29a targeted extracellular matrix components expression. Consistently, miR-29a administration intensified the relevance of uMSCs to abridge BPVC-aggravated fibrosis. Our data support that miR-29a is a promising pro-angiogenic and anti-fibrotic microRNA which delivers numerous advantages to endorse angiogenesis, perfusion recovery, and protect against fibrosis post injury. Amalgamation of nucleic acid-based strategy (miR-29a) together with the stem cell-based strategy (uMSCs) may be an innovative and eminent strategy to accelerate the healing process post skeletal muscle injury.
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Human Umbilical Cord Mesenchymal Stem Cells Extricate Bupivacaine-Impaired Skeletal Muscle Function via Mitigating Neutrophil-Mediated Acute Inflammation and Protecting against Fibrosis. Int J Mol Sci 2019; 20:ijms20174312. [PMID: 31484417 PMCID: PMC6747081 DOI: 10.3390/ijms20174312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 08/29/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022] Open
Abstract
Skeletal muscle injury presents a challenging traumatological dilemma, and current therapeutic options remain mediocre. This study was designed to delineate if engraftment of mesenchymal stem cells derived from umbilical cord Wharton's jelly (uMSCs) could aid in skeletal muscle healing and persuasive molecular mechanisms. We established a skeletal muscle injury model by injection of myotoxin bupivacaine (BPVC) into quadriceps muscles of C57BL/6 mice. Post BPVC injection, neutrophils, the first host defensive line, rapidly invaded injured muscle and induced acute inflammation. Engrafted uMSCs effectively abolished neutrophil infiltration and activation, and diminished neutrophil chemotaxis, including Complement component 5a (C5a), Keratinocyte chemoattractant (KC), Macrophage inflammatory protein (MIP)-2, LPS-induced CXC chemokine (LIX), Fractalkine, Leukotriene B4 (LTB4), and Interferon-γ, as determined using a Quantibody Mouse Cytokine Array assay. Subsequently, uMSCs noticeably prevented BPVC-accelerated collagen deposition and fibrosis, measured by Masson's trichrome staining. Remarkably, uMSCs attenuated BPVC-induced Transforming growth factor (TGF)-β1 expression, a master regulator of fibrosis. Engrafted uMSCs attenuated TGF-β1 transmitting through interrupting the canonical Sma- And Mad-Related Protein (Smad)2/3 dependent pathway and noncanonical Smad-independent Transforming growth factor beta-activated kinase (TAK)-1/p38 mitogen-activated protein kinases signaling. The uMSCs abrogated TGF-β1-induced fibrosis by reducing extracellular matrix components including fibronectin-1, collagen (COL) 1A1, and COL10A1. Most importantly, uMSCs modestly extricated BPVC-impaired gait functions, determined using CatWalk™ XT gait analysis. This work provides several innovative insights into and molecular bases for employing uMSCs to execute therapeutic potential through the elimination of neutrophil-mediated acute inflammation toward protecting against fibrosis, thereby rescuing functional impairments post injury.
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Korkmaz M, Eyigor S. Association between sarcopenia and rheumatological diseases. World J Rheumatol 2019; 9:1-8. [DOI: 10.5499/wjr.v9.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/12/2018] [Accepted: 01/05/2019] [Indexed: 02/06/2023] Open
Abstract
Sarcopenia (“sarx” for muscle, “penia” for loss) is an important problem in the elderly. Although muscle loss is a part of natural aging, excessive loss that limits physical activity is considered pathological. Sarcopenia is associated with age, malnutrition, physical inactivity, inflammatory stress and hormonal changes. Although relationships between sarcopenia and various chronic inflammatory diseases have been shown, the role of rheumatologic disease in sarcopenia development is currently unknown. Our aim in this mini-review was to increase the awareness of clinicians to sarcopenia, and to evaluate studies in which the relationship between sarcopenia and rheumatologic diseases was investigated. We also aimed to determine whether the available literature was sufficient to confirm a strong relationship between these conditions. Although our findings showed that diseases such as rheumatoid arthritis, osteoarthritis and systemic sclerosis may have a role in sarcopenia development and progress, the methodologies and results of the majority of studies were insufficient in determining direct causal relationships. We believe future studies would benefit from focusing on the factors and causes of sarcopenia, with a goal of determining the factors associated with rheumatologic disease that are most effective in sarcopenia development.
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Affiliation(s)
- Murat Korkmaz
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Afyon Saglik Bilimleri University, Afyonkarahisar 03000, Turkey
| | - Sibel Eyigor
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Ege University, Izmir 35100, Turkey
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Reina D, Gómez-Vaquero C, Díaz-Torné C, Solé JMN. Assessment of nutritional status by dual X-Ray absorptiometry in women with rheumatoid arthritis: A case-control study. Medicine (Baltimore) 2019; 98:e14361. [PMID: 30732168 PMCID: PMC6380876 DOI: 10.1097/md.0000000000014361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 12/23/2022] Open
Abstract
Rheumatoid arthritis (RA) has been related to an impairment of the nutritional status. Body mass index (BMI) has been used but questions arise about how to properly evaluate nutritional status in RA patients. Few studies have evaluated it by dual-energy X-ray absorptiometry.In women with RA, to analyze:Case-control study including 89 women with RA. The control group was composed by 100 patients affected by non-inflammatory rheumatic disorders. Study variables included age, RA duration, history, activity and disability, and in relation to nutritional status: BMI, serum albumin (ALB), whole body DXA assessment, and skeletal muscle index (SMI).Mean age of patients was 62 ± 8 years, mean duration of RA was 14 ± 9 years, mean disease activity score (DAS28) was 3.7 ± 1.4 and mean Health Assessment Questionnaire was 0.88 ± 0.77. BMI was 27.43 ± 5.16 Kg/m in patients and 27.78 ± 3.98 Kg/m in controls (P: ns). ALB was within normal range in all patients.By whole body DXA, RA patients presented a statistically significant lower lean mass in all locations and lower fat mass in limbs than controls. Patients had a redistribution of fat mass to trunk. Lean mass directly correlated with fat mass.Neither BMI nor ALB correlated with DXA parameters.BMI, appendicular lean mass and SMI correlated inversely with disease duration. Trunk lean mass correlated inversely, and fat mass directly, with RA disability parameters.RA patients fulfilled criteria of sarcopenia in 44% of cases versus 19% of controls (P <.001). In RA patients, regarding SMI, BMI showed a high specificity to detect sarcopenia (94% of the patients with low BMI had sarcopenia) but low sensitivity (47% of the patients with normal BMI or overweight had sarcopenia).RA patients have an impairment of nutritional status associated to disease duration that looks like sarcopenia and that is not predicted by BMI.
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The extra-articular impacts of rheumatoid arthritis: moving towards holistic care. BMC Rheumatol 2018; 2:32. [PMID: 30886982 PMCID: PMC6390577 DOI: 10.1186/s41927-018-0039-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/04/2018] [Indexed: 12/16/2022] Open
Abstract
Although treat-to-target has revolutionised the outcomes of patients with rheumatoid arthritis (RA) there is emerging evidence that attaining the target of remission is insufficient to normalise patients’ quality of life, and ameliorate the extra-articular impacts of RA. RA has a broad range of effects on patient’s lives, with four key “extra-articular” impacts being pain, depression and anxiety, fatigue and rheumatoid cachexia. All of these are seen frequently; for example, studies have reported that 1 in 4 patients with RA have high-levels of fatigue. Commonly used drug treatments (including simple analgesics, non-steroidal anti-inflammatory drugs and anti-depressants) have, at most, only modest benefits and often cause adverse events. Psychological strategies and dynamic and aerobic exercise all reduce issues like pain and fatigue, although their effects are also only modest. The aetiologies of these extra-articular impacts are multifactorial, but share overlapping components. Consequently, patients are likely to benefit from management strategies that extend beyond the assessment and treatment of synovitis, and incorporate more broad-based, or “holistic”, assessments of the extra-articular impacts of RA and their management, including non-pharmacological approaches. Innovative digital technologies (including tablet and smartphone “apps” that directly interface with hospital systems) are increasingly available that can directly capture patient-reported outcomes during and between clinic visits, and include them within electronic patient records. These are likely to play an important future role in delivering such approaches.
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Metsios GS, Kitas GD. Physical activity, exercise and rheumatoid arthritis: Effectiveness, mechanisms and implementation. Best Pract Res Clin Rheumatol 2018; 32:669-682. [DOI: 10.1016/j.berh.2019.03.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Cardiovascular Safety of Biologics and JAK Inhibitors in Patients with Rheumatoid Arthritis. Curr Rheumatol Rep 2018; 20:42. [DOI: 10.1007/s11926-018-0752-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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35
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Pérez-Baos S, Prieto-Potin I, Román-Blas JA, Sánchez-Pernaute O, Largo R, Herrero-Beaumont G. Mediators and Patterns of Muscle Loss in Chronic Systemic Inflammation. Front Physiol 2018; 9:409. [PMID: 29740336 PMCID: PMC5928215 DOI: 10.3389/fphys.2018.00409] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/04/2018] [Indexed: 12/25/2022] Open
Abstract
Besides its primary function in locomotion, skeletal muscle (SKM), which represents up to half of human's weight, also plays a fundamental homeostatic role. Through the secretion of soluble peptides, or myokines, SKM interacts with major organs involved in metabolic processes. In turn, metabolic cues from these organs are received by muscle cells, which adapt their response accordingly. This is done through an intricate intracellular signaling network characterized by the cross-talking between anabolic and catabolic pathways. A fine regulation of the network is required to protect the organism from an excessive energy expenditure. Systemic inflammation evokes a catabolic reaction in SKM known as sarcopenia. In turn this response comprises several mechanisms, which vary depending on the nature of the insult and its magnitude. In this regard, aging, chronic inflammatory systemic diseases, osteoarthritis and idiopathic inflammatory myopathies can lead to muscle loss. Interestingly, sarcopenia may persist despite remission of chronic inflammation, an issue which warrants further research. The Janus kinase/signal transducer and activator of transcription (JAK/STAT) system stands as a major participant in muscle loss during systemic inflammation, while it is also a well-recognized orchestrator of muscle cell turnover. Herein we summarize current knowledge about models of sarcopenia, their triggers and major mediators and their effect on both protein and cell growth yields. Also, the dual action of the JAK/STAT pathway in muscle mass changes is discussed. We highlight the need to unravel the precise contribution of this system to sarcopenia in order to design targeted therapeutic strategies.
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Affiliation(s)
- Sandra Pérez-Baos
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Iván Prieto-Potin
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Jorge A Román-Blas
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Olga Sánchez-Pernaute
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Raquel Largo
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Gabriel Herrero-Beaumont
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
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Boutrup RJ, Farup J, Vissing K, Kjaer M, Mikkelsen UR. Skeletal muscle stem cell characteristics and myonuclei content in patients with rheumatoid arthritis: a cross-sectional study. Rheumatol Int 2018; 38:1031-1041. [PMID: 29651539 DOI: 10.1007/s00296-018-4028-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/07/2018] [Indexed: 11/24/2022]
Abstract
To investigate satellite cells (SCs) and myonuclei characteristics in patients with rheumatoid arthritis (RA). Resting biopsies from m. vastus lateralis were obtained from thirteen RA patients and thirteen matched healthy controls (CON). Muscle biopsies were immunohistochemically stained and analyzed for fiber type specific content of SCs (Pax7+), proliferating SCs (Pax7+/MyoD+) and differentiating SCs (myogenin+). Furthermore, we quantified fiber type specific content of myonuclei and myofiber cross-sectional area (CSA). Finally, newly formed/regenerating fibers expressing neonatal MHC (nMHC+) were determined. The fiber type specific number of SCs did not differ between RA patients and CON, nor did the content of proliferating or differentiating SCs. In contrast, the content of myonuclei per fiber was higher in RA patients than CON for both type I (2.01 ± 0.41 vs. 1.42 ± 0.40 myonuclei/fiber, p < 0.01) and type II fibers (2.01 ± 0.41 vs. 1.37 ± 0.32 myonuclei/fiber, p < 0.01). No differences were observed in fiber composition, fiber type specific CSA or content of nMHC+ fibers. Our results indicate an increased propensity for myogenic differentiation of SC leading to an elevated myonuclear content in the skeletal muscle of RA patients. It is hypothesized that this could be a compensatory regulatory response related to the chronic inflammation in these patients.
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Affiliation(s)
- Rasmus Jentoft Boutrup
- Section for Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 6, 8000, Aarhus C, Denmark.
| | - Jean Farup
- Research Laboratory for Biochemical Pathology, Department for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kristian Vissing
- Section for Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 6, 8000, Aarhus C, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Ramer Mikkelsen
- Section for Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 6, 8000, Aarhus C, Denmark.,Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Morsley K, Berntzen B, Erwood L, Bellerby T, Williamson L. Progressive resistance training (PRT) improves rheumatoid arthritis outcomes: A district general hospital (DGH) model. Musculoskeletal Care 2018; 16:13-17. [PMID: 28401689 DOI: 10.1002/msc.1193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Rheumatoid cachexia is common in rheumatoid arthritis (RA) patients and develops soon after diagnosis, despite adequate drug therapy. It is associated with multiple adverse effects on body composition, function and mortality. Progressive resistance training (PRT) improves these outcomes but is not widely prescribed outside of a research setting. The aim of the present study was to explore the practicality and effectiveness of providing PRT to patients in a district general hospital within the constraints of existing resources. METHODS Patients attending a rheumatology clinic were invited to participate in a weekly PRT class for 6 weeks, supervised by a physiotherapist. Outcome measures included: body composition measures (waist and hip circumference, weight, percentage body fat); functional measures (grip strength, 60-s sit-to-stand test, single leg stance, Health Assessment Questionnaire); mood; fatigue and disease activity measures (sleep scale, hospital anxiety and depression scale, Functional Assessment of Chronic Illness Therapy, pain visual analogue scale). These were measured at baseline and at 6 weeks. RESULTS A total of 83 patients completed the programme (60% female, mean age 51.2 years), of whom 34.9% had early RA. Improvements were seen in multiple measures inpatients with early RA and with established inflammatory arthritis, and were not affected by age or gender. CONCLUSIONS Patients with early and established inflammatory arthritis alike benefited from a 6-week PRT programme provided within a National Health Service setting. Although further work is needed to look at long-term effects, we suggest that this intervention should be more widely available.
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Affiliation(s)
- Maurizio Cutolo
- Research Laboratories and Academic Division of Rheumatology, Department of Internal Medicine, Postgraduate School of Rheumatology, University of Genova, Genova, Italy
| | - Elena Nikiphorou
- Academic Rheumatology Department, King's College London & The Whittington Hospital NHS Trust, London, UK
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39
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Tournadre A, Pereira B, Dutheil F, Giraud C, Courteix D, Sapin V, Frayssac T, Mathieu S, Malochet-Guinamand S, Soubrier M. Changes in body composition and metabolic profile during interleukin 6 inhibition in rheumatoid arthritis. J Cachexia Sarcopenia Muscle 2017; 8:639-646. [PMID: 28316139 PMCID: PMC5566648 DOI: 10.1002/jcsm.12189] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 12/22/2016] [Accepted: 01/10/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Rheumatoid 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. METHODS Twenty-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. RESULTS Compared 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. CONCLUSIONS Despite 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.
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Affiliation(s)
- Anne Tournadre
- Rheumatology Department, CHU Clermont-Ferrand, 58 rue Montalembert, BP 69, 63003, Clermont-Ferrand CEDEX, France.,UNH-UMR 1019, INRA, University Clermont Auvergne, 58 rue Montalembert, BP 321, 63009, Clermont-Ferrand CEDEX, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, 58 rue Montalembert, BP 69, 63003, Clermont-Ferrand CEDEX, France
| | - Fréderic Dutheil
- Department of Preventive and Occupational Medicine, CHU Clermont-Ferrand, 58 rue Montalembert, BP 69, 63003, Clermont-Ferrand CEDEX, France.,Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, University Clermont Auvergne, CNRS LaPSCo, Physiological and Psychosocial Stress, 24 Avenue des Landais, 63171, Aubière, France.,Faculty of Health, Australian Catholic University, Melbourne, Victoria, Australia
| | - Charlotte Giraud
- Rheumatology Department, CHU Clermont-Ferrand, 58 rue Montalembert, BP 69, 63003, Clermont-Ferrand CEDEX, France
| | - Daniel Courteix
- Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, University Clermont Auvergne, CNRS LaPSCo, Physiological and Psychosocial Stress, 24 Avenue des Landais, 63171, Aubière, France.,Faculty of Health, Australian Catholic University, Melbourne, Victoria, Australia
| | - Vincent Sapin
- Biochemistry and Molecular Biology Department, CHU Clermont-Ferrand, 58 rue Montalembert, BP 69, 63003, Clermont-Ferrand CEDEX, France.,University Clermont Auvergne, EA7281, 28 Place Henri-Dunant, 63001, Clermont-Ferrand, France
| | - Thomas Frayssac
- Rheumatology Department, CHU Clermont-Ferrand, 58 rue Montalembert, BP 69, 63003, Clermont-Ferrand CEDEX, France
| | - Sylvain Mathieu
- Rheumatology Department, CHU Clermont-Ferrand, 58 rue Montalembert, BP 69, 63003, Clermont-Ferrand CEDEX, France
| | - Sandrine Malochet-Guinamand
- Rheumatology Department, CHU Clermont-Ferrand, 58 rue Montalembert, BP 69, 63003, Clermont-Ferrand CEDEX, France
| | - Martin Soubrier
- Rheumatology Department, CHU Clermont-Ferrand, 58 rue Montalembert, BP 69, 63003, Clermont-Ferrand CEDEX, France.,UNH-UMR 1019, INRA, University Clermont Auvergne, 58 rue Montalembert, BP 321, 63009, Clermont-Ferrand CEDEX, France
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Little RD, Prieto-Potin I, Pérez-Baos S, Villalvilla A, Gratal P, Cicuttini F, Largo R, Herrero-Beaumont G. Compensatory anabolic signaling in the sarcopenia of experimental chronic arthritis. Sci Rep 2017; 7:6311. [PMID: 28740214 PMCID: PMC5524910 DOI: 10.1038/s41598-017-06581-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/14/2017] [Indexed: 01/06/2023] Open
Abstract
Inflammatory activity in rheumatoid arthritis may alter the regulation of muscle mass leading to a secondary sarcopenia, commonly termed rheumatoid cachexia (RC). We characterized alterations to muscle structure and various pro-inflammatory, catabolic and regenerative markers in an animal model of RC. Antigen induced arthritis (AiA) was performed in 20 male adult rabbits. AiA animals exhibited significantly less weight gain, a markedly elevated serum C-reactive protein (CRP), lighter muscles with shorter cross-sectional diameter and increased myonuclei when compared to controls. Atrogin-1 and MuRF-1 were up-regulated alongside an increase in IL-1β, active NF-κB and a higher ratio of phosphorylated to inactive p38 MAPK. CCL-2 and TNF levels were reduced and IL-6 was unchanged between groups. We observed decreased pSTAT3, unchanged pSTAT1 and Myf5, but increased Pax7, MyoD and myogenin. AiA rabbits had a reduction in myostatin from gastrocnemii and synovium with a congruent decrease in serum myostatin compared to controls. Chronic arthritis induced an RC-like secondary sarcopenia with increased muscle protein breakdown. Elevated IL-1β may trigger proteolysis via elevated NF-κB and p38 MAPK signaling with a compensatory anabolic response suggested by myonuclear expansion, increased Pax7, MyoD and myogenin, reduced pSTAT3 as well as reduced serum, synovial and muscular myostatin.
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Affiliation(s)
- Robert D Little
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Iván Prieto-Potin
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
- Red Temática de Investigación Cooperativa de Envejecimiento y Fragilidad (RETICEF)-Instituto de Salud Carlos III, Madrid, Spain
| | - Sandra Pérez-Baos
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Amanda Villalvilla
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Paula Gratal
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Raquel Largo
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain.
- Red Temática de Investigación Cooperativa de Envejecimiento y Fragilidad (RETICEF)-Instituto de Salud Carlos III, Madrid, Spain.
| | - Gabriel Herrero-Beaumont
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
- Red Temática de Investigación Cooperativa de Envejecimiento y Fragilidad (RETICEF)-Instituto de Salud Carlos III, Madrid, Spain
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Wilkinson TJ, Lemmey AB, Jones JG, Sheikh F, Ahmad YA, Chitale S, Maddison PJ, O'brien TD. Can Creatine Supplementation Improve Body Composition and Objective Physical Function in Rheumatoid Arthritis Patients? A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017; 68:729-37. [PMID: 26414681 DOI: 10.1002/acr.22747] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/10/2015] [Accepted: 09/22/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Rheumatoid cachexia (muscle wasting) in rheumatoid arthritis (RA) patients contributes to substantial reductions in strength and impaired physical function. The objective of this randomized controlled trial was to investigate the effectiveness of oral creatine (Cr) supplementation in increasing lean mass and improving strength and physical function in RA patients. METHODS In a double-blind design, 40 RA patients were randomized to either 12 weeks' supplementation of Cr or placebo. Body composition (dual x-ray absorptiometry and bioelectrical impedance spectroscopy [BIS]), strength, and objectively assessed physical function were measured at baseline, day 6, week 12, and week 24. Data analysis was performed by analysis of covariance. RESULTS Cr supplementation increased appendicular lean mass (ALM; a surrogate measure of muscle mass) by mean ± SE 0.52 ± 0.13 kg (P = 0.004 versus placebo), and total LM by 0.60 ± 0.37 kg (P = 0.158). The change in LM concurred with the gain in intracellular water (0.64 ± 0.22 liters; P = 0.035) measured by BIS. Despite increasing ALM, Cr supplementation, relative to placebo, failed to improve isometric knee extensor strength (P = 0.408), handgrip strength (P = 0.833), or objectively assessed physical function (P = 0.335-0.764). CONCLUSION In patients with RA, Cr supplementation increased muscle mass, but not strength or objective physical function. No treatment-related adverse effects were reported, suggesting that Cr supplementation may offer a safe and acceptable adjunct treatment for attenuating muscle loss; this treatment may be beneficial for patients experiencing severe rheumatoid cachexia.
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Affiliation(s)
| | | | - Jeremy G Jones
- Peter Maddison Rheumatology Centre, Llandudno Hospital, Llandudno, North Wales, UK, and Bangor University, Bangor, UK
| | - Fazal Sheikh
- Peter Maddison Rheumatology Centre, Llandudno Hospital, Llandudno, North Wales, UK, and Bangor University, Bangor, UK
| | - Yasmeen A Ahmad
- Peter Maddison Rheumatology Centre, Llandudno Hospital, Llandudno, North Wales, UK, and Bangor University, Bangor, UK
| | - Sarang Chitale
- Peter Maddison Rheumatology Centre, Llandudno Hospital, Llandudno, North Wales, UK, and Bangor University, Bangor, UK
| | - Peter J Maddison
- Peter Maddison Rheumatology Centre, Llandudno Hospital, Llandudno, North Wales, UK, and Bangor University, Bangor, UK
| | - Thomas D O'brien
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Hugo M, Pierreisnard A, Mehsen-Cetre N, Gin H, Schaeverbeke T, Rigalleau V. Action of tocilizumab on energy expenditure in rheumatoid arthritis: A prospective study using calorimetry and actimetry. Joint Bone Spine 2016; 84:751-752. [PMID: 28017819 DOI: 10.1016/j.jbspin.2016.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Marie Hugo
- Nutrition-Diabetology department, CHU Bordeaux, avenue Magellan, 33600 Pessac, France.
| | - Audrey Pierreisnard
- Rheumatology department, CHU Bordeaux, avenue Magellan, 33600 Pessac, France
| | - Nadia Mehsen-Cetre
- Rheumatology department, CHU Bordeaux, avenue Magellan, 33600 Pessac, France
| | - Henri Gin
- Nutrition-Diabetology department, CHU Bordeaux, avenue Magellan, 33600 Pessac, France
| | | | - Vincent Rigalleau
- Nutrition-Diabetology department, CHU Bordeaux, avenue Magellan, 33600 Pessac, France
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Dessein PH, Solomon A, Hollan I. Metabolic abnormalities in patients with inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:901-915. [DOI: 10.1016/j.berh.2016.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/01/2016] [Accepted: 10/03/2016] [Indexed: 12/20/2022]
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Reduced Appendicular Lean Body Mass, Muscle Strength, and Size of Type II Muscle Fibers in Patients with Spondyloarthritis versus Healthy Controls: A Cross-Sectional Study. ScientificWorldJournal 2016; 2016:6507692. [PMID: 27672678 PMCID: PMC5031855 DOI: 10.1155/2016/6507692] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/17/2016] [Accepted: 08/09/2016] [Indexed: 01/08/2023] Open
Abstract
Introduction. The purpose of this study was to investigate body composition, muscle function, and muscle morphology in patients with spondyloarthritis (SpA). Methods. Ten male SpA patients (mean ± SD age 39 ± 4.1 years) were compared with ten healthy controls matched for sex, age, body mass index, and self-reported level of physical exercise. Body composition was measured by dual energy X-ray absorptiometry. Musculus quadriceps femoris (QF) strength was assessed by maximal isometric contractions prior to test of muscular endurance. Magnetic resonance imaging of QF was used to measure muscle size and calculate specific muscle strength. Percutaneous needle biopsy samples were taken from m. vastus lateralis. Results. SpA patients presented with significantly lower appendicular lean body mass (LBM) (p = 0.02), but there was no difference in bone mineral density, fat mass, or total LBM. Absolute QF strength was significantly lower in SpA patients (p = 0.03) with a parallel trend for specific strength (p = 0.08). Biopsy samples from the SpA patients revealed significantly smaller cross-sectional area (CSA) of type II muscle fibers (p = 0.04), but no difference in CSA type I fibers. Conclusions. Results indicate that the presence of SpA disease is associated with reduced appendicular LBM, muscle strength, and type II fiber CSA.
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Autoimmune atherosclerosis in 3D: How it develops, how to diagnose and what to do. Autoimmun Rev 2016; 15:756-69. [DOI: 10.1016/j.autrev.2016.03.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 12/11/2022]
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van Onna M, Boonen A. The challenging interplay between rheumatoid arthritis, ageing and comorbidities. BMC Musculoskelet Disord 2016; 17:184. [PMID: 27118031 PMCID: PMC4845363 DOI: 10.1186/s12891-016-1038-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022] Open
Abstract
Background The incidence of rheumatoid arthritis (RA) is expected to increase over the next 10 years in the European Union because of the increasing proportion of elderly people. As both RA and ageing are associated with emerging comorbidities such as cardiovascular disease, malignancies and osteoporosis, these factors will have a profound effect on the management of RA. In addition, both increasing age and comorbidities may independently alter commonly used RA-specific outcome measures. Discussion Age-related decline in immune cell functions (immunosenescence), such as a decrease in T-cell function, may contribute to the development of RA, as well as comorbidity. The chronic immune stimulation that occurs in RA may also lead to premature ageing and comorbidity. The interplay between RA, ageing and (emerging) comorbidities is interesting but complex. Cardiovascular disease, lung disease, malignancies, bone and muscle wasting and neuropsychiatric disease all occur more frequently in RA patients as compared to the general population. It is unclear how RA should be managed in ‘today’s world of multiple comorbidities’. Evidence that treatment of RA improves comorbidities is currently lacking, although some promising indirect observations are available. On the other hand, there is limited evidence that medication regularly prescribed for comorbidities, such as statins, might improve RA disease activity. Both ageing and comorbidity have an independent effect on commonly used outcome measures in the RA field, such as the Health Assessment Questionnaire (HAQ) and the clinical disease activity index (CDAI). Prospective studies, that also account for the presence of comorbidity in (elderly) RA patients are therefore urgently needed. To address gaps in knowledge, future research should focus on the complex interdependencies between RA, ageing and comorbidity. In addition, these findings should be integrated into daily clinical practice by developing and testing integrated and coordinated health care services. Adaptation of management recommendations is likely required. Summary The elderly RA patient who also deals with (emerging) comorbidities presents a unique challenge to treating clinicians. A paradigm shift from disease-centered to goal-oriented approach is needed to develop adequate health care services for these patients.
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Affiliation(s)
- Marloes van Onna
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), Maastricht University, P. Debyelaan 25, Maastricht, 6202 AZ, The Netherlands.
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), Maastricht University, P. Debyelaan 25, Maastricht, 6202 AZ, The Netherlands
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Lemmey AB. Rheumatoid cachexia: the undiagnosed, untreated key to restoring physical function in rheumatoid arthritis patients? Rheumatology (Oxford) 2015; 55:1149-50. [PMID: 26672906 DOI: 10.1093/rheumatology/kev412] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrew B Lemmey
- Rehabilitation of Musculoskeletal Disorders with Exercise Sciences Research Group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
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Peluso I, Palmery M. The relationship between body weight and inflammation: Lesson from anti-TNF-α antibody therapy. Hum Immunol 2015; 77:47-53. [PMID: 26472017 DOI: 10.1016/j.humimm.2015.10.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 10/08/2015] [Accepted: 10/11/2015] [Indexed: 01/23/2023]
Abstract
Obesity is associated with many pathological conditions. Tumor Necrosis Factor-α (TNF-α) is one of the key mediators of inflammation involved in the obesity-related insulin resistance development. We aim to review the human evidence useful to clarify the relationship between inflammation and body weight, with particular reference to TNF-α. Genetic polymorphisms and epigenetic factors, such as diet, could affect TNF-α activity. TNF-α is associated with obesity, but also with anorexia and cachexia. Despite the role of TNF-α in obesity-related diseases, anti-TNF-α antibody therapy is associated with an increase in adiposity. In conclusion the reviewed results suggest that inflammation is more likely a consequence rather than a cause of obesity.
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Affiliation(s)
- Ilaria Peluso
- Center of Nutrition, Council for Agricultural Research and Economics (CREA-NUT), Via Ardeatina 546, 00178 Rome, Italy
| | - Maura Palmery
- Department of Physiology and Pharmacology "V. Erspamer", "Sapienza" University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy.
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Affiliation(s)
- Andreas D Flouris
- Department of Exercise Science, FAME Laboratory, University of Thessaly, Trikala, Greece.
| | - Petros C Dinas
- Department of Exercise Science, FAME Laboratory, University of Thessaly, Trikala, Greece
- Institute of Sport, Faculty of Education, Health, and Wellbeing, University of Wolverhampton, Walsall, UK
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Mikkelsen UR, Dideriksen K, Andersen MB, Boesen A, Malmgaard-Clausen NM, Sørensen IJ, Schjerling P, Kjær M, Holm L. Preserved skeletal muscle protein anabolic response to acute exercise and protein intake in well-treated rheumatoid arthritis patients. Arthritis Res Ther 2015; 17:271. [PMID: 26407995 PMCID: PMC4583143 DOI: 10.1186/s13075-015-0758-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 08/17/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Rheumatoid arthritis (RA) is often associated with diminished muscle mass, reflecting an imbalance between protein synthesis and protein breakdown. To investigate the anabolic potential of both exercise and nutritional protein intake we investigated the muscle protein synthesis rate and anabolic signaling response in patients with RA compared to healthy controls. Methods Thirteen RA patients (age range 34–84 years; diagnosed for 1–32 years, median 8 years) were individually matched with 13 healthy controls for gender, age, BMI and activity level (CON). Plasma levels of C-reactive protein (CRP), interleukin (IL)-6 and tumor necrosis factor (TNF)-α were measured using enzyme-linked immunosorbent assay (ELISA) in resting blood samples obtained on two separate days. Skeletal muscle myofibrillar and connective tissue protein fractional synthesis rate (FSR) was measured by incorporation of the amino acid 13C6-phenylalanine tracer in the overnight fasted state for 3 hours (BASAL) and 3 hours after intake of whey protein (0.5 g/kg lean body mass) alone (PROT, 3 hrs) and in combination with knee-extensor exercise (EX) with one leg (8 × 10 reps at 70 % of 1RM; PROT + EX, 3 hrs). Expression of genes related to inflammatory signaling, myogenesis and muscle growth/atrophy were analyzed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). Results CRP was significantly higher in the RA patients (2.25 (0.50) mg/l) than in controls (1.07 (0.25) mg/l; p = 0.038) and so was TNF-α (RA 1.18 (0.30) pg/ml vs. CON 0.64 (0.07) pg/ml; p = 0.008). Muscle myofibrillar protein synthesis in both RA patients and CON increased in response to PROT and PROT + EX, and even more with PROT + EX (p < 0.001), with no difference between groups (p > 0.05). The gene expression response was largely similar in RA vs. CON, however, expression of the genes coding for TNF-α, myogenin and HGF1 were more responsive to exercise in RA patients than in CON. Conclusions The study demonstrates that muscle protein synthesis rate and muscle gene expression can be stimulated by protein intake alone and in combination with physical exercise in patients with well-treated RA to a similar extent as in healthy individuals. This indicates that moderately inflamed RA patients have maintained their muscle anabolic responsiveness to physical activity and protein intake. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0758-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulla Ramer Mikkelsen
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Hospital bldg 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark. .,Section for Sports Science, Institute of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus C, Denmark.
| | - Kasper Dideriksen
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Hospital bldg 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - Mads Bisgaard Andersen
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Hospital bldg 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - Anders Boesen
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Hospital bldg 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - Nikolai Mølkjær Malmgaard-Clausen
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Hospital bldg 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - Inge Juul Sørensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark.
| | - Peter Schjerling
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Hospital bldg 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - Michael Kjær
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Hospital bldg 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
| | - Lars Holm
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Hospital bldg 8, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark. .,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
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