Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients.
RA typically features rheumatoid cachexia [loss of muscle mass (MM) and excessive total fat mass (TFM), especially trunk FM], which contributes to physical disability. Since rheumatoid cachexia is driven by inflammation, it would be anticipated that the success of tight control of disease activity, such as treat-to-target (T2T), in attenuating inflammation would benefit body composition and physical function. This aim of this cross-sectional study was to assess the impact of T2T on body composition and objectively assessed function in RA patients.



A total of 82 RA patients exclusively treated by T2T, were compared with 85 matched sedentary healthy controls (HCs). Body composition was estimated by DXA, with appendicular lean mass the surrogate measure of total MM. Physical function was assessed by knee extensor strength, handgrip strength, 30 s sit-to-stands, 8' up and go, and 50' walk (tests which reflect the ability to perform activities of daily living).



Although generally well treated (mean DAS28 = 2.8, with 49% in remission), RA patients had ∼10% proportionally less appendicular lean mass and were considerably fatter (by ∼27%), particularly in the trunk (∼32%), than HCs. All measures of function were 24-34% poorer in the RA patients relative to HC.



Despite marked improvements in disease control (most patients achieving or approaching remission), the relative loss of MM and increased adiposity in RA patients compared with matched HCs was similar to that observed pre-T2T. Additionally, performance of objective function tests was unchanged from that reported by our group for pre-T2T RA patients. Thus T2T, even in responsive RA patients, did not attenuate rheumatoid cachexia or improve objectively assessed function.
Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor a.b.lemmey@bangor.ac.uk.
Andrew B
AB
Lemmey
Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor.
Thomas J
TJ
Wilkinson
Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd.
Rebecca J
RJ
Clayton
Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd.
Fazal
F
Sheikh
Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor.
John
J
Whale
Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor.
Hope S J
HS
Jones
Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd.
Yasmeen A
YA
Ahmad
Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd.
Sarang
S
Chitale
Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd.
Jeremy G
JG
Jones
Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Peter Maddison Rheumatology Centre, Llandudno Hospital, Betsi Cadwaladr University Health Board, Gwynedd.
Peter J
PJ
Maddison
Rehabilitation of Musculoskeletal Disorders with Exercise Sciences group, School of Sport, Health and Exercise Sciences, Bangor University, Bangor Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
Thomas D
TD
O'Brien
D000203:Activities of Daily Living; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000517:prevention & control*; D001823:Body Composition / Q000502:physiology*; D002100:Cachexia / Q000503:physiopathology / Q000517:prevention & control; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D015444:Exercise / Q000502:physiology; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D016896:Treatment Outcome; D055105:Waist Circumference / Q000502:physiology
body composition; physical function; rheumatoid arthritis; rheumatoid cachexia; treat-to-target