Table 1.
Primary studies assessing RC in patients with RA.
| First author | Study | Participants | RA Diagnosticcriteria | Body composition method | RC | Results | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Origin | Design | Duration | Recruitmentsite | N (% women) | RR (%) | Age (years) | Diagnostic criteria | Prevalence (%) | ||||
| Hugo41 | France | CC | 2010–4 | Bordeaux University Hospital | 57 (73%) patients with RA and 7 healthy controls | NR | 57±10MSD | ACR | DXA | Engvall et al. 18 and Elkan et al. 44 | 18 (Engvall) and 28 (Elkan) | Low levels of PA and treatment by GC were associated with the nutritional complications of RA. Patients with RC had low FFM and high % fat. MS and RC were not associated with each other. Hypermetabolism is suspected as the cause of RC. |
| Lombard34 | S. Africa | CS | NR | Tygerberg Hospital and Groote Schuur Hospital | 251 (83%) patients with RA | NR | 57.4±13.6MSD | NR | Skinfolds (Durnin and Womersley) and the Siri equations | Elkan et al. 44 | 12 | Nearly half of the studied population with RA was classified as obese (45.9 %) and a further quarter as overweight (26.8 %). RC was present in some patients not classified as obese. |
| Van Bokhorst35 | The Netherlands | CS | 2011 | Department of Rheumatology at the VU Medical Center | 103 (79%) consecutive patients with RA | NR | 26–90R | NR | BIA | Evans et al. 48 | 1 | The recently proposed definitions of both ‘pre-cachexia’ and ‘cachexia’ are not clinically useful to identify and diagnose impaired nutritional status in RA patients treated with currently available anti-rheumatic drugs. |
| Santillán-Díaz22 | Mexico | CC | NR | Rheumatology Clinic at the Instituto Nacional de Rehabilitación | 94 (92.55%) patients with RA, 20 as cases (with RC) and 74 as RC-free patients | NR | 51.4±13.4MSD | ACR/EULAR116 | BIA (Systems Quantum X, Clinton Twp, Mi, USA) | a vector analysis method (BIVA Software 2002) NOD117 | 21.3 | Association between RC and disease activity was not observed, the interaction of folic acid and methotrexate consumption behaved as a protective factor for the presence of RC. |
| Metsios43 | UK | CC | NR | Department of Rheumatology of the Dudley Group of Hospitals | 34 patients with RA and RC and 366 patients with RA (RC-free), all from the DRACCO cohort (73%) | NR | 54–73R | NR | BIA (Tanita BC418MA, Tokyo, Japan) | Engvall et al. 18 | 8.5 | FFM and albumin levels were decreased in the RC group, but BF (%BW) was not different compared to the RC-free patients. No differences were detected in either the classical, or novel CVD risk factors, 10-year CVD risk or the prevalence of established CVD. |
| Maghraoui36 | Morocco | CS | June–December 2013 | Military Hospital of Rabat | 178 patients with RA (82.6%) | NR | 54.1±11.5MSD | ACR | DXA (Lunar Prodigy) | Engvall et al. 18 | 53.9 (53.7% women, 54.8% men) | Between women with and without RC, those with RC had a longer disease duration, greater disease activity, higher steroid cumulative dose, and a greater prevalence of erosive arthritis. Half of the patients with RA may have RC with a normal/high BMI, this condition was associated with disease activity and low hip BMD, but not with VF. |
| Elkan45 and Elkan44 | Sweden | CS | NR | Rheumatology Department, Karolinska University Hospital Huddinge | 80 consecutive outpatients with RA (76%) | NR | 61M | NR | DXA (GE-Lunar Prodigy) and BIA (Tanita Corp., Tokyo, Japan) | Engvall et al. 18 | 20 (18% women and 26% men) | RC and central obesity were common in patients with RA. Patients with RC displayed reduced FFM together with stable or increased FM, with high levels of LDL, low levels of athero-protective anti-PC and high frequency of hypertension. No difference was recorded in the diet of patients with RC, or not. Low disease activity was associated with a high-SFA diet. |
| Engvall18 | Sweden | CS | NR | Karolinska University Hospital | 60 patients with RA (83%) | NR | 65M | ACR | DXA (GE-Lunar Prodigy) | Engvall et al. 18 | 38 | A large proportion of inpatients with RA, mainly women, had RC. DAS28, CRP, and IL-6 correlated negatively with LBM. |
| Papichev37 | Russia | CS | NR | NR | 110 patients with RA (NR%) | NR | 52.2±8.1MSD | ACR/EULAR | DXA | Engvall et al. 18 | 22.7 | The prevalence of RC was the same in patients taking GC (22.2%) and who didn’t (23,7%). Median cumulative dose of oral GC in those with RC was higher, but not significant. Median serum fetuin-A levels were only slightly significantly lower in patients with RC. |
| Ångström38 | Sweden | CS | 2013–6 | Department of Rheumatology, University Hospital of Umeå | 87 patients with early RA (NR%) | 71.3 | 60M | ACR/EULAR | DXA (GE-Lunar Prodigy) | Engvall et al. 18 and Elkan et al. 44 | 24 (Engvall) and 32 (Elkan) | RC was associated with reduced aerobic capacity, low-intensity PA, and higher BMI, waist circumference, BW and ESR at the time of diagnosis. |
| Roubenoff12 † | USA | CS | † | † | 24 patients with RA | † | † | † | BIA | † | 67 | LBM was inversely associated with the number of swollen joints. Among the whole participant group, there was a trend toward increasing disability with decreased LBM after adjusting for joint pain and disease duration. |
| Pineda-Juárez39 | Mexico | CS | 2015–6 | Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra | 224 women with a diagnosis of RA (100%) | NR | 52.7±14.2MSD | ACR/EULAR | BIA (RJL Quantum X, RJL Systems) | BIVA | 51.8 | All cachectic subjects, independently of BMI group, had lower levels of serum albumin. |
| Müller40 | Estonia | CC | 2012–4 | Patients: NR Controls: Postal invitations |
91 patients with early RA (72%) and 328 healthy controls (54%) | NR | 19–79R | ACR/EULAR | DXA (Lunar Prodigy Advance) | ALM/height2 <20th PC of the sex specific values and BF> 25% for men and >35% for women | 26.4 | Body composition of patients with recent onset RA differed from that of controls. Approximately 12.4% of women at early stage RA were sarcopenic and overfat (had RC). |
| Murillo-Saich42 | Mexico | CC | NR | NR | 84 women with RA and 127 healthy women as controls (100%) | NR | 24–89R | ACR | DXA (Lunar Prodigy Advance) | Engvall et al. 18 | 14.3 | No difference was observed in myostatin levels between RA patients with or without RC. It was estimated that 91.7% of patients with RC were sedentary. |
| Santo47 | Brazil | Prospective cohort (1 year) | 2015–7 | Hospital de Clínicas de Porto Alegre, HCPA | 90 patients with RA (88.9%) | 90 | 56.5±7.3MSD | ACR/EULAR | DXA (GE-Lunar Prodigy Primo) | Engvall et al. 18 | 12* | RC was common, classic cachexia was absent. Disease activity and use of DMARD were associated with changes in body composition and physical function, underscoring the importance of aiming for remission when treating RA. |
ACR: American College of Rheumatology; ALM: appendicular lean mass (the sum of the lean tissue in the arms and legs); anti-PC: antibodies against phosphorylcholine; BF: body fat; BIA: bioelectrical impedance analysis; BIVA: Bioelectrical impedance vector analysis; BMD: bone mineral density; BMI: body mass index; CC: case-control; CRP: c-reactive protein; CS: cross-sectional; DAS28: disease activity score (28 joints); DMARD: disease-modifying antirheumatic drug; DRACCO: Dudley RA comorbidity cohort; DXA: dual-energy X-Ray absorptiometry; ESR: erythrocyte sedimentation rate; EULAR: European Alliance of Associations for Rheumatology; FFM: mat-free mass; FM: fat mass; GC: glucocorticoid; IL-6: interleukine 6; LBM: lean body mass; LDL: low-density lipoprotein;
Mmedian; MS: metabolic syndrome; MSD: mean ± standard deviation; NOD: nod other defined; NR: not reported; PA: physical activity; PC: percentile;
R: range; RA: rheumatoid arthritis; RC: rheumatoid cachexia; RR: response rate; SFA: saturated fatty acids; VF: vertebral fractures; *no difference was noted in the prevalence of RC between baseline and the end of the study (at 1 year);
†
access to the full-text of the publication was not possible, thus, only available data from the abstract are presented.