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Ayyıldız A, Yılmaz F, Altındaş H, Çiftci S, Kuran B. Effects of Aerobic and Resistive Exercise on Muscle Measurements and Body Composition in Female Patients With Rheumatoid Arthritis. Am J Phys Med Rehabil 2023; 102:1076-1084. [PMID: 37204935 DOI: 10.1097/phm.0000000000002283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE This study aimed to show the effects of different exercise types on disease activity, pain, functional status, and quality of life in female patients with rheumatoid arthritis with low disease activity or in remission and supported these findings with body composition and muscle measurements. DESIGN This randomized controlled prospective study screened female patients aged 20-50 years with rheumatoid arthritis. The patients were randomized into 12-wk resistance exercise, aerobic exercise, and control groups. RESULTS The mean age of the 66 patients was 42.5 ± 5.6 yrs. In the resistance and aerobic exercise groups compared with the control group, a positive significant difference was found in the pain, disease activity, several subparameters of quality of life, M. gastrocnemius, and M. biceps femoris muscle thickness measurements, and fat mass in the lower limbs before and after treatment ( P < 0.05). Compared with the other groups, the resistance exercise group showed a significant improvement in M. rectus femoris and M. vastus intermedius muscle thickness measurements, whole body fat mass, whole body and lower extremity lean body mass, and timed up and go test when comparing before and after treatment ( P < 0.05). CONCLUSIONS In rheumatoid arthritis patients, resistance exercises led to a significant increase in muscle thickness, functional status, lean body mass compared with other exercises; resistance exercises also resulted in a significant reduction in pain and disease activity.
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Affiliation(s)
- Aylin Ayyıldız
- From the Department of Physical Medicine and Rehabilitation, Ministry of Health, Avcılar Murat Kölük State Hospital, Istanbul, Turkey (AA); and Department of Physical Medicine and Rehabilitation, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey (FY, HA, SÇ, BK)
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2
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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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Yeung SSY, Reijnierse EM, Trappenburg MC, Meskers CGM, Maier AB. Clinical determinants of resting metabolic rate in geriatric outpatients. Arch Gerontol Geriatr 2020; 89:104066. [PMID: 32371344 DOI: 10.1016/j.archger.2020.104066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 03/21/2020] [Accepted: 03/28/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Accurate estimation of the energy requirements including resting metabolic rate (RMR) is important for optimal nutritional care, yet its clinical determinants are unknown. This study examined the associations between clinical determinants of the Comprehensive Geriatric Assessment (CGA) domains with RMR among geriatric outpatients. MATERIALS & METHODS Data were retrieved from cohorts of community-dwelling older adults (n = 84, 54 female) referring to geriatrics outpatient mobility clinics in both Amsterdam, The Netherlands and Melbourne, Australia. Determinants within domains of the CGA included diseases (number, type and severity of diseases, polypharmacy), nutrition (body weight, body mass index, absolute and relative skeletal muscle mass, fat-free mass and fat mass, risk of malnutrition), physical function (handgrip strength, Short Physical Performance Battery, Timed Up & Go), cognition (Mini-Mental State Examination), psychological wellbeing (Geriatric Depression Scale) and blood pressure. RMR was objectively measured using indirect calorimetry with a canopy hood. Association between the clinical determinants with standardized RMR (country and sex-specific z-score) were analysed with linear regression adjusted for age, sex and body weight. RESULTS Determinants within the nutritional domain were associated with RMR; body weight showed the strongest association with RMR. Significant associations between determinants within the nutritional domain with RMR disappeared after further adjustment for body weight. None of the other domains were associated with RMR. CONCLUSIONS Body weight is the strongest clinical determinant of RMR and should be taken into account when estimating RMR in geriatric care.
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Affiliation(s)
- Suey S Y Yeung
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Marijke C Trappenburg
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Department of Internal Medicine, Amstelland Hospital, Amstelveen, the Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
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Pal Y, Bandyopadhyay N, Pal RS, Ahmed S, Bandopadhyay S. Perspective and Potential of A2A and A3 Adenosine Receptors as Therapeutic Targets for the Treatment of Rheumatoid Arthritis. Curr Pharm Des 2019; 25:2859-2874. [DOI: 10.2174/1381612825666190710111658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/01/2019] [Indexed: 01/10/2023]
Abstract
Adenosine is a purine nucleoside which is an effective controller of inflammation. The inflammatory effect of adenosine is expressed via its four receptor subtypes viz. A1, A2A, A2B and A3. The various inflammatory conditions including rheumatoid arthritis (RA) are initiated by adenosine receptors of which A2A and A3 play a vital role. RA primarily is an auto-immune disorder which is manifested as chronic inflammation in the synovial lining of joints. In order to develop an effective treatment, the role of cytokines, IL–1, TNF-α and IL–6 is crucial. Besides, the knowledge of PI3K-PKB/Akt and NF-kB signaling pathway is also important to understand the antiinflammatory targets. Methotrexate along with various other molecules like, NSAIDs and DMARDs are presently used as treatment lines for controlling RA. The enhanced knowledge of the preclinical stages and pathogenesis along with recent potent therapeutics raises the hopes that RA can be prevented in the near future.
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Affiliation(s)
- Yogendra Pal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Bhauti, Kanpur, Uttar Pradesh 209305, India
| | - Nabamita Bandyopadhyay
- Molecular Biology Division, National Institute of Malarial Research (NIMR), Dwarka, New Delhi, Delhi 110077, India
| | - Rashmi S. Pal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Bhauti, Kanpur, Uttar Pradesh 209305, India
| | - Sarfaraz Ahmed
- Global Institute of Pharmaceutical Education and Research, Kashipur, Udham Singh Nagar, Uttarakhand 244713, India
| | - Shantanu Bandopadhyay
- Faculty of Pharmacy, Naraina Vidya Peeth Group of Institutions, Panki, Kanpur, Uttar Pradesh 208020, India
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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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Genovese M, Westhovens R, Meuleners L, Van der Aa A, Harrison P, Tasset C, Kavanaugh A. Effect of filgotinib, a selective JAK 1 inhibitor, with and without methotrexate in patients with rheumatoid arthritis: patient-reported outcomes. Arthritis Res Ther 2018; 20:57. [PMID: 29566740 PMCID: PMC5865354 DOI: 10.1186/s13075-018-1541-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/08/2018] [Indexed: 02/08/2023] Open
Abstract
Background The aim was to assess patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA) treated with filgotinib during two phase 2b, 24-week, randomized, placebo-controlled studies. Methods Patients with moderate-to-severe active RA and an inadequate response to methotrexate (MTX) were randomized to daily placebo or filgotinib 50 mg, 100 mg, or 200 mg as add-on therapy to MTX (NCT01888874) or as monotherapy (NCT01894516). At week 12, nonresponders receiving filgotinib 50 mg in both studies or placebo in the add-on study, and all patients receiving placebo as monotherapy, were re-assigned to filgotinib 100 mg. PROs were measured using the Health Assessment Questionnaire - Disability Index (HAQ-DI) including Patient Pain assessed by visual analog scale, and the Patient Global Assessment of Disease Activity (Patient Global), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale (Version 4), and the 36-Item Short Form Health Survey (SF-36). Results At week 12, improvements in all PROs, apart from the SF-36 mental component in the add-on study, were statistically better with filgotinib than placebo; some improvements were noted as early as the first assessment time point (week 1 or week 4). Filgotinib improved HAQ-DI by 0.58–0.84 points, FACIT-Fatigue by 6.9–11.4 points, Patient Global by 25.2–35.6 mm, and Pain by 24.2–37.9 mm; scores were maintained or improved to week 24. Across all PROs, more patients achieved minimal clinically important differences and normative values with filgotinib 200 mg than placebo. Patients re-assigned to filgotinib 100 mg at week 12 experienced improvements in PROs between weeks 12 to 24. Conclusions Filgotinib as MTX add-on therapy or as monotherapy demonstrated rapid and sustained (to 24 weeks) improvements in health-related quality of life and functional status in patients with active RA. Trial registration MTX add-on study: ClinicalTrials.gov, NCT01888874. Registered on 28 June 2013. Monotherapy study: ClinicalTrials.gov, NCT01894516. Registered on 10 July 2013. Electronic supplementary material The online version of this article (10.1186/s13075-018-1541-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark Genovese
- Division of Immunology and Rheumatology, Stanford School of Medicine, Stanford, CA, USA. .,Division of Immunology and Rheumatology, Stanford School of Medicine, 1000 Welch RD #203, Palo Alto, CA, 94304, USA.
| | - Rene Westhovens
- Department of Development and Regeneration KU Leuven, Skeletal Biology and Engineering Research Center; Rheumatology, University Hospitals Leuven, Leuven, Belgium
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An unfavorable body composition is common in early arthritis patients: A case control study. PLoS One 2018; 13:e0193377. [PMID: 29565986 PMCID: PMC5863963 DOI: 10.1371/journal.pone.0193377] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/31/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND An unfavorable body composition is often present in chronic arthritis patients. This unfavorable composition is a loss of muscle mass, with a stable or increased (abdominal) fat mass. Since it is unknown when this unfavorable composition develops, we compared body composition in disease-modifying antirheumatic drugs (DMARD)-naive early arthritis patients with non-arthritis controls and explored the association, in early arthritis patients, with disease activity and traditional cardiovascular risk factors. METHODS 317 consecutive early arthritis patients (84% rheumatoid arthritis according to 2010 ACR/EULAR criteria) and 1268 age-/gender-/ethnicity-matched non-arthritis controls underwent a Dual-energy X-ray absorptiometry scan to assess fat percentage, fat mass index, fat mass distribution and appendicular lean (muscle) mass index. Additionally, disease activity, health assessment questionnaire (HAQ), acute phase proteins, lipid profile and blood pressure were evaluated. RESULTS Loss of muscle mass (corrected for age suspected muscle mass) was 4-5 times more common in early arthritis patients, with a significantly lower mean appendicular lean mass index (females 6% and males 7% lower, p<0.01). Patients had more fat distributed to the trunk (females p<0.01, males p = 0.07) and females had a 4% higher mean fat mass index (p<0.01). An unfavorable body composition was associated with a higher blood pressure and an atherogenic lipid profile. There was no relationship with disease activity, HAQ or acute phase proteins. CONCLUSION Loss of muscle mass is 4-5 times more common in early arthritis patients, and is in early arthritis patients associated with a higher blood pressure and an atherogenic lipid profile. Therefore, cardiovascular risk is already increased at the clinical onset of arthritis making cardiovascular risk management necessary in early arthritis patients.
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Guimarães MFBR, Pinto MRDC, Raid RGSC, Andrade MVMD, Kakehasi AM. Which is the best cutoff of body mass index to identify obesity in female patients with rheumatoid arthritis? A study using dual energy X-ray absorptiometry body composition. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:279-285. [PMID: 28743353 DOI: 10.1016/j.rbre.2016.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/16/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Standard anthropometric measures used to diagnose obesity in the general population may not have the same performance in patients with rheumatoid arthritis. OBJECTIVE To determine cutoff points for body mass index (BMI) and waist circumference (WC) for detecting obesity in women with rheumatoid arthritis (RA) by comparing these standard anthropometric measures to a dual-energy X-ray absorptiometry (DXA)-based obesity criterion. PATIENTS AND METHOD Adult female patients with more than six months of diagnosis of RA underwent clinical evaluation, with anthropometric measures and body composition with DXA. RESULTS Eighty two patients were included, mean age 55±10.7 years. The diagnosis of obesity in the sample was about 31.7% by BMI, 86.6% by WC and 59.8% by DXA. Considering DXA as golden standard, cutoff points were identified for anthropometric measures to better approximate DXA estimates of percent body fat: for BMI value≥25kg/m2 was the best for definition of obesity in female patients with RA, with sensitivity of 80% and specificity of 60%. For WC, with 80% of sensitivity and 35% of specificity, the best value to detect obesity was 86cm. CONCLUSION A large percentage of patients were obese. The traditional cutoff points used for obesity were not suitable for our sample. For this female population with established RA, BMI cutoff point of 25kg/m2 and WC cutoff point of 86cm were the most appropriate to detect obesity.
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Affiliation(s)
| | - Maria Raquel da Costa Pinto
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Serviço de Reumatologia, Belo Horizonte, MG, Brazil
| | - Renata G Santos Couto Raid
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Tecnologia em Radiologia, Belo Horizonte, MG, Brazil
| | - Marcus Vinícius Melo de Andrade
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte, MG, Brazil
| | - Adriana Maria Kakehasi
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Serviço de Reumatologia, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento do Aparelho Locomotor, Belo Horizonte, MG, Brazil
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Baik YS, Park JW, Kim J, Kim WG, Oh S, Cho SI, Song YW, Shin K. Nutrient Intake in Postmenopausal Rheumatoid Arthritis Women with Osteoporosis: Results from the Korean National Health and Nutrition Examination Survey. JOURNAL OF RHEUMATIC DISEASES 2017. [DOI: 10.4078/jrd.2017.24.1.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yeon Soo Baik
- Department of Epidemiology, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jee Won Park
- Department of Epidemiology, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jihye Kim
- Division of Rheumatology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Won Gyoung Kim
- Department of Nutrition Service, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sung-il Cho
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
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Soeters P, Bozzetti F, Cynober L, Forbes A, Shenkin A, Sobotka L. Defining malnutrition: A plea to rethink. Clin Nutr 2016; 36:896-901. [PMID: 27769782 DOI: 10.1016/j.clnu.2016.09.032] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/19/2016] [Accepted: 09/30/2016] [Indexed: 01/07/2023]
Abstract
In a recent consensus report in Clinical Nutrition the undernourished category of malnutrition was proposed to be defined and diagnosed on the basis of a low BMI or unintentional weight loss combined with low BMI or FFMI with certain cut off points. The definition was endorsed by ESPEN despite recent endorsement of a very different definition. The approach aims to assess whether nutritional intake is sufficient but is imprecise because a low BMI does not always indicate malnutrition and individuals with increasing BMI's may have decreasing FFM's. The pathophysiology of individuals, considered to be malnourished in rich countries and in areas with endemic malnutrition, results predominantly from deficient nutrition combined with infection/inflammation. Both elements jointly determine body composition and function and consequently outcome of disease, trauma or treatment. When following the consensus statement only an imprecise estimate is acquired of nutritional intake without knowing the impact of inflammation. Most importantly, functional abilities are not assessed. Consequently it will remain uncertain how well the individual can overcome stressful events, what the causes are of dysfunction, how to set priorities for treatment and how to predict the effect of nutritional support. We therefore advise to consider the pathophysiology of malnourished individuals leading to inclusion of the following elements in the definition of malnutrition: a disordered nutritional state resulting from a combination of inflammation and a negative nutrient balance, leading to changes in body composition, function and outcome. A precise diagnosis of malnutrition should be based on assessment of these elements.
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Affiliation(s)
- P Soeters
- Faculty of Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - F Bozzetti
- Faculty of Medicine, University of Milan, 20100 Milan, Italy
| | - L Cynober
- Service de Biochimie, Hôpital Cochin, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Biological Nutrition Laboratory, EA 4466, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - A Forbes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - A Shenkin
- Department of Clinical Chemistry, University of Liverpool, Liverpool, United Kingdom
| | - L Sobotka
- Third Department of Medicine, Medical Faculty Hospital Hradec Králové, Charles University, Prague, Czech Republic
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Abstract
While the most obvious manifestations of rheumatoid arthritis (RA) involve inflammation and damage in the synovial joints, the systemic effects of the condition are widespread and life-threatening. Of particular interest is the 'lipid paradox' of RA, where patients with a numerically equivocal starting lipid profile have a significantly raised risk of cardiovascular (CV) events and response to therapy results in a 'normalization' of lipid levels and reduction in events. Changes in lipids can be seen before overt disease manifestations which suggest that they are closely linked to the more widespread inflammation-driven metabolic changes associated with tumour necrosis factor (TNF). Cachexia involves a shift in body mass from muscle to fat, which may or may not directly increase the cardiovascular risk. However, since TNF inhibition is associated with reduction in cardiovascular events, it does suggest that these widespread metabolic changes involving lipids are of importance. Analysis of single lipids or metabolites have been used to identify some of the key changes, but more recently, metabolomic and lipidomic approaches have been applied to identify a broad spectrum of small molecule changes and identify potentially altered metabolic pathways. Further work is needed to understand fully the metabolic changes in lipid profiles and identify novel ways of targeting desired profile changes, but work so far does suggest that a better understanding may allow management of patients to downregulate the systemic effects of their disease that puts them at risk of cardiovascular complications.
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Affiliation(s)
- Catherine M McGrath
- School of Immunity and Infection, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK,
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Tolusso B, Alivernini S, Gigante MR, Ferraccioli G, Gremese E. Biomolecular features of inflammation in obese rheumatoid arthritis patients: management considerations. Expert Rev Clin Immunol 2016; 12:751-62. [PMID: 26950427 DOI: 10.1586/1744666x.2016.1159132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Adipose tissue is an active organ playing a role not only in metabolism but also in immune and inflammatory processes, releasing several pro-inflammatory mediators. This can explain the possible association between obesity and rheumatoid arthritis (RA) and its role in the progression of the disease. Adipose and synovial tissues share common histological features of local inflammation in terms of activation of target tissues infiltrating cells (i.e. myeloid cells). Among the so-called adipocytokines, PEDF and Chemerin orchestrate the cellular cross-talk between adipose and myeloid cells, being possible biomarkers to monitor the effect of weight loss or the decrease of adipose tissue in patients with RA. Moreover, dietary intervention has been demonstrated to reduce Chemerin as well as IL-6 and MCP-1 expression. Finally, epigenetic regulators such as micro-RNAs (i.e. miR-155) are key regulators of myeloid cells activation in RA and obesity as well as in adipocytes. In this review, we will summarize the biological link between obesity/overweight state and RA focusing on pathophysiological mechanisms, consequences and management considerations.
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Affiliation(s)
- Barbara Tolusso
- a Division of Rheumatology, Institute of Rheumatology , Catholic University of the Sacred Heart , Rome , Italy
| | - Stefano Alivernini
- a Division of Rheumatology, Institute of Rheumatology , Catholic University of the Sacred Heart , Rome , Italy
| | - Maria Rita Gigante
- a Division of Rheumatology, Institute of Rheumatology , Catholic University of the Sacred Heart , Rome , Italy
| | - Gianfranco Ferraccioli
- a Division of Rheumatology, Institute of Rheumatology , Catholic University of the Sacred Heart , Rome , Italy
| | - Elisa Gremese
- a Division of Rheumatology, Institute of Rheumatology , Catholic University of the Sacred Heart , Rome , Italy
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Guimarães MFBR, da Costa Pinto MR, Raid RGSC, Andrade MVMD, Kakehasi AM. Which is the best cutoff of body mass index to identify obesity in female patients with rheumatoid arthritis? A study using dual energy X-ray absorptiometry body composition. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 57:S0482-5004(16)00020-6. [PMID: 26924005 DOI: 10.1016/j.rbr.2015.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/03/2015] [Accepted: 09/16/2015] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Standard anthropometric measures used to diagnose obesity in the general population may not have the same performance in patients with rheumatoid arthritis. OBJECTIVE To determine cutoff points for body mass index (BMI) and waist circumference (WC) for detecting obesity in women with rheumatoid arthritis (RA) by comparing these standard anthropometric measures to a dual-energy x-ray absorptiometry (DXA)-based obesity criterion. PATIENTS AND METHOD Adult female patients with more than six months of diagnosis of RA underwent clinical evaluation, with anthropometric measures and body composition with DXA. RESULTS Eighty two patients were included, mean age 55±10.7 years. The diagnosis of obesity in the sample was about 31.7% by BMI, 86.6% by WC and 59.8% by DXA. Considering DXA as golden standard, Cutoff points were identified for anthropometric measures to better approximate DXA estimates of percent body fat: for BMI value ≥ 25kg/m2 was the best for definition of obesity in female patients with RA, with sensitivity of 80% and specificity of 60%. For WC, with 80% of sensitivity and 35% of specificity, the best value to detect obesity was 86cm. CONCLUSION A large percentage of patients were obese. The traditional cutoff points used for obesity were not suitable for our sample. For this female population with established RA, BMI cutoff point of 25kg/m2 and WC cutoff point of 86cm were the most appropriate to detect obesity.
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Affiliation(s)
| | - Maria Raquel da Costa Pinto
- Serviço de Reumatologia, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | - Renata G Santos Couto Raid
- Faculdade de Tecnologia em Radiologia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | - Marcus Vinícius Melo de Andrade
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | - Adriana Maria Kakehasi
- Serviço de Reumatologia, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil; Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
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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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Hurtado-Torres GF, González-Baranda LL, Abud-Mendoza C. Rheumatoid cachexia and other nutritional alterations in rheumatologic diseases. ACTA ACUST UNITED AC 2015; 11:316-21. [PMID: 26094123 DOI: 10.1016/j.reuma.2015.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/18/2015] [Accepted: 03/13/2015] [Indexed: 01/04/2023]
Abstract
The prevalence of nutritional alterations in rheumatologic diseases ranges from 4 to 95%, depending on the detection method used. Formerly described as the single term rheumatoid cachexia, nutritional alterations can currently be grouped and subdivided based on the physiopathological mechanisms involved: chronic disease-related inflammatory conditions (cachexia), malnutrition associated to acute malnutrition inflammatory conditions (protein-caloric malnutrition) and starvation-related malnutrition. Clinical manifestations of malnutrition associated to rheumatic diseases vary from the patient with low weight or overweight and obesity; with lean body mass depletion as well as functional repercussions, and impact of quality of life as a common denominator. Additionally, the associated increase in body fat mass increases the risk for cardiovascular morbidity. A multidisciplinary approach towards rheumatic diseases should include aspects oriented towards prevention, early identification, diagnosis and correction of nutritional alterations.
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Affiliation(s)
- Gilberto Fabián Hurtado-Torres
- Departamento de Medicina Interna y Nutrición Clínica, Hospital Central Dr. Ignacio Morones Prieto/UASLP, San Luis Potosí, México.
| | - Lourdes Larisa González-Baranda
- Departamento de Medicina Interna y Nutrición Clínica, Hospital Central Dr. Ignacio Morones Prieto/UASLP, San Luis Potosí, México
| | - Carlos Abud-Mendoza
- Unidad Regional de Reumatología y Osteoporosis, Hospital Central Dr. Ignacio Morones Prieto/UASLP, San Luis Potosí, México
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Profile of energy expenditure in people with rheumatoid arthritis. Disabil Health J 2015; 8:514-20. [PMID: 25953350 DOI: 10.1016/j.dhjo.2015.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/05/2015] [Accepted: 03/13/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND No definitive conclusions have been made on the levels of physical activity in the rheumatoid arthritis (RA) population. Similarly no clear consensus has been reached on the correlates and predictors of physical activity in the population. OBJECTIVE To profile total energy expenditure (TEE), resting energy expenditure (REE) and physical activity related energy expenditure (PAEE) levels using a validated objective measurement tool and to determine demographic and health related factors which influence and predict TEE and PAEE levels in individuals with RA. METHODS Fifty nine (41 female, 18 male) individuals with RA were recruited to this cross sectional study. Energy expenditure was measured over seven days using SenseWear Armband. Correlational analysis and logistic regression were used to examine the relationship between demographic and health related factors and TEE, REE and PAEE. RESULTS A profile of energy expenditure in RA individuals was developed in terms of levels, differences between genders and differences between weekdays and weekend days. Median TEE, PAEE and REE were 2204.0, 409.5 and 1506.2 kcal/day respectively. Energy expenditure was associated with factors such as gender, age, body mass index, employment status, disease severity and smoking. CONCLUSION The findings add to the growing research assessing energy expenditure in the RA population and strengthen the position due to the use of an objective validated tool. Some recommendations on what factors are associated with energy expenditure in the RA population are made, thus unveiling ways to tailor physical activity type interventions in this group.
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Masuko K. Rheumatoid cachexia revisited: a metabolic co-morbidity in rheumatoid arthritis. Front Nutr 2014; 1:20. [PMID: 25988122 PMCID: PMC4428367 DOI: 10.3389/fnut.2014.00020] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/03/2014] [Indexed: 12/21/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease in which pro-inflammatory cytokines, including tumor necrosis factor (TNF)-α, play a crucial role. The chronic inflammation, combined with reduced physical activity, leads to muscle wasting whereas fat mass would be maintained; the resulting abnormal metabolic state is described as rheumatoid cachexia. Since the loss of muscle volume would be compensated by the increased fat mass, body mass index (BMI) is reported not to reflect the nutritional status in RA patients. The implication of rheumatoid cachexia for cardiovascular risk and clinical prognosis is not clearly understood, however, adequate control of disease activity in combination with appropriate physical exercise could be the most important strategy to control rheumatoid cachexia and related metabolic problems.
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Affiliation(s)
- Kayo Masuko
- Graduate School of Nutritional Science, Sagami Women's University , Sagamihara-shi , Japan
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19
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Choe JY, Park SH, Lee H, Kwon HH, Kim SK. Resting energy expenditure is not associated with disease activity in women with rheumatoid arthritis: cross-sectional study. Korean J Intern Med 2014; 29:516-24. [PMID: 25045300 PMCID: PMC4101599 DOI: 10.3904/kjim.2014.29.4.516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/07/2014] [Accepted: 01/28/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Increased resting energy expenditure (REE) in rheumatoid arthritis (RA) patients is thought to be caused by hypermetabolism associated with production of proinflammatory cytokines. Our aim in the present study was to explore the possible association between REE and disease activity in females with RA. METHODS A total of 499 female RA patients were recruited to this cross-sectional study assessing REE scores on disease activity indices (the routine assessment of patient index data 3 [RAPID3], the disease activity score 28, and the clinical/simplified disease activity index [CDAI/SDAI]) and the levels of RA-associated autoantibodies (rheumatoid factor and anticyclic citrullinated peptide [anti-CCP] antibodies). Age-matched healthy female controls (n = 131) were also enrolled. RESULTS REE did not differ between RA patients (all patients, and those in remission or not) and controls, or between RA patients in remission or not (p > 0.05 for all comparisons). Increased REE in total RA patients was associated with younger age and a higher body mass index (BMI) (p < 0.001 and p < 0.001, respectively), but not with disease activity index scores on any of RAPID3, CDAI, or SDAI. BMI was the only clinical parameter exhibiting a significant relationship with REE quartiles (Q1 to Q4; p < 0.001); none of disease duration, functional status, or anti-CCP antibody titer in RA patients was significantly related to REE, based on analysis of covariance. CONCLUSIONS We found no association between REE and disease activity in RA patients, implying that energy metabolism in RA patients might be independent of RA-associated systemic inflammation.
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Affiliation(s)
- Jung-Yoon Choe
- Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sung-Hoon Park
- Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hwajeong Lee
- Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hyun Hee Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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Konijn NPC, van Tuyl LHD, Bultink IEM, Lems WF, Earthman CP, van Bokhorst-de van der Schueren MAE. Making the invisible visible: bioelectrical impedance analysis demonstrates unfavourable body composition in rheumatoid arthritis patients in clinical practice. Scand J Rheumatol 2014; 43:273-8. [DOI: 10.3109/03009742.2013.852239] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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21
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Lombard LA, du Plessis LM, Visser J. Body composition of rheumatoid arthritis patients in the City of Cape Town, South Africa. Clin Rheumatol 2013; 33:467-76. [DOI: 10.1007/s10067-013-2414-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/16/2013] [Accepted: 10/18/2013] [Indexed: 11/24/2022]
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Romero FI, Martínez-Calatrava MJ, Sánchez-Pernaute O, Gualillo O, Largo R, Herrero-Beaumont G. Pharmacological modulation by celecoxib of cachexia associated with experimental arthritis and atherosclerosis in rabbits. Br J Pharmacol 2011; 161:1012-22. [PMID: 20633016 DOI: 10.1111/j.1476-5381.2010.00957.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Non-steroidal anti-inflammatory drugs improve inflammatory cachexia in several conditions. Thus, we have explored inhibition of cyclooxygenase-2 (COX-2) in an experimental model of rheumatoid cachexia in rabbits. EXPERIMENTAL APPROACH Chronic arthritis was induced in immunized rabbits by repeated intra-articular injections of ovalbumin. To increase the degree of systemic inflammation and also to induce atherosclerotic lesions, the animals were fed a hyperlipidaemic diet (2% cholesterol and 6% peanut oil) and were given an endothelial injury of the femoral artery. Rabbits were randomized to receive the COX-2 inhibitor celecoxib (10 mg·kg⁻¹ ·day⁻¹) or no treatment. After 4 weeks, sera, peripheral mononuclear cells and vessel specimens were collected. KEY RESULTS Inhibition of COX-2 by celecoxib modulated the systemic inflammatory response and increased total cholesterol and triglyceride levels. Celecoxib also minimized weight loss and prevented serum albumin fall. At a vascular level, celecoxib reduced COX-2 protein in the femoral arterial wall, but did not modify size or the macrophage infiltration of femoral lesions nor the percentage of rabbits with spontaneous aortic plaques. CONCLUSIONS AND IMPLICATIONS Our animal model induced a severe inflammatory cachexia, comparable to that of persistently active rheumatoid arthritis. The inhibition of COX-2 by celecoxib improves this state, suggesting that COX products play an important role in its development, without affecting the development or the progression of vascular lesions. Overall, these results suggest that celecoxib might be considered as a new therapeutic tool for the treatment of rheumatoid cachexia.
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Affiliation(s)
- F I Romero
- Joint and Bone Research Unit, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Abstract
Both cachexia and cardiovascular disease are strongly associated with rheumatoid arthritis (RA) and linked to the chronic inflammatory process. Typically, rheumatoid cachexia occurs in individuals with normal or increased BMI (reduced muscle mass and increased fat mass). Classic cachexia (reduced muscle mass and reduced fat mass) is rare in RA but is associated with high inflammatory activity and aggressive joint destruction in patients with a poor cardiovascular prognosis. Conversely, obesity is linked to hypertension and dyslipidemia but, paradoxically, lower RA disease activity and less cardiovascular disease-related mortality. Rheumatoid cachexia might represent the 'worst of both worlds' with respect to cardiovascular outcome, but until diagnostic criteria for this condition are agreed upon, its effect on cardiovascular disease risk remains controversial.
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Smedslund G, Byfuglien MG, Olsen SU, Hagen KB. Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials. ACTA ACUST UNITED AC 2010; 110:727-35. [PMID: 20430134 DOI: 10.1016/j.jada.2010.02.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 09/03/2009] [Indexed: 11/27/2022]
Abstract
This systematic review assesses the effectiveness and safety of dietary interventions for rheumatoid arthritis. Randomized controlled trials comparing any dietary manipulation with an ordinary diet were included. Eight randomized controlled trials with a total of 366 patients were included. One trial found that fasting, followed by 13 months on a vegetarian eating plan, might reduce pain (mean difference on a zero to 10 scale -1.89, 95% confidence interval [CI] -3.62 to -0.16). Another single trial found that a 12-week Cretan Mediterranean eating plan might reduce pain (mean difference on a 0 to 100 scale -14.00, 95% CI -23.6 to -4.37). Due to inadequate data reporting, the effects of vegan eating plans and elimination diets are uncertain. When comparing any dietary manipulation with an ordinary diet we found a higher total drop-out of 8% (risk difference 0.08, 95% CI -0.01 to 0.17), higher treatment-related drop-out of 5% (risk difference 0.05, 95% CI -0.03 to 0.14) and a significantly higher weight loss (weighted mean difference -3.24, 95% CI -4.81 to -1.67 kg) in the diet groups compared to the control groups. The effects of dietary manipulation, including vegetarian, Mediterranean, and elemental eating plans, and elimination diets on rheumatoid arthritis are still uncertain due to the included studies being small, single trials with moderate to high risk of bias. We conclude that higher dropout rates and weight loss in the groups with dietary manipulation indicate that potential adverse effects should not be ignored.
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Affiliation(s)
- Geir Smedslund
- National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Association between physical activity energy expenditure and inflammatory markers in sedentary overweight and obese women. Int J Obes (Lond) 2010; 34:1387-95. [PMID: 20368709 DOI: 10.1038/ijo.2010.55] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Chronic subclinical inflammation and regular physical activity have opposing relationships to obesity-related metabolic diseases. Yet, the association between chronic inflammation and physical activity has rarely been examined in obese subjects. We examined the association between physical activity energy expenditure (PAEE), total (TEE) and resting energy expenditure (REE) and cardiorespiratory fitness (VO(2)peak) with inflammatory markers in overweight/obese women. DESIGN Cross-sectional study. METHODS The study included 152 overweight/obese postmenopausal women who were sedentary and free of chronic/inflammatory diseases (mean age: 57.5 (95% confidence interval (CI) 56.7-58.3) years, body mass index (BMI): 32.5 (95% CI 31.8-33.2) kg m(-2)). The following parameters were measured: TEE (doubly labeled water), REE (indirect calorimetry), PAEE (as (TEE x 0.90)-REE), VO(2)peak (ergocycle) and serum high-sensitive C-reactive protein (hsCRP), haptoglobin, soluble tumor necrosis factor-α receptor 1 (sTNFR1), interleukin-6, orosomucoid and white blood cells. RESULTS Sedentary women with the highest tertile of PAEE (1276 (1233-1319) kcal day(-1)) had lower concentrations of hsCRP and haptoglobin than those in the lowest tertile (587 (553-621) kcal day(-1)) after adjustment for fat mass (P<0.05). Soluble TNFR1 was positively correlated with VO(2)peak, TEE and REE (P<0.05), and hsCRP and orosomucoid were positively associated with REE (P<0.01), whereas haptoglobin was negatively associated with PAEE (P<0.05). In stepwise regression analyses that examined the concomitant associations of components of energy expenditure with inflammatory markers, PAEE remained the only predictor of hsCRP and haptoglobin (P<0.05), explaining 14 and 5%, respectively, of their variation,whereas REE was the only predictor of orosomucoid (r (2) = 0.05, P = 0.02) after adjustment for fat mass. Adding leptin to the regression models results in similar relationships between inflammatory markers and components of energy expenditure. CONCLUSION PAEE is an independent predictor of hsCRP and haptoglobin in sedentary overweight/obese postmenopausal women free of chronic disease. Our data support the role of physical activity in reducing subclinical inflammation and risk of metabolic and cardiovascular diseases.
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Stavropoulos-Kalinoglou A, Metsios GS, Smith JP, Panoulas VF, Douglas KMJ, Jamurtas AZ, Koutedakis Y, Kitas GD. What predicts obesity in patients with rheumatoid arthritis? An investigation of the interactions between lifestyle and inflammation. Int J Obes (Lond) 2009; 34:295-301. [PMID: 19859075 DOI: 10.1038/ijo.2009.220] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess whether physical activity, diet or inflammation is a more important determinant of body mass index (BMI) and body fat (BF) in patients with rheumatoid arthritis (RA). METHODS A total of 150 RA patients (102 female) were assessed for BMI and BF. Their habitual physical activity was assessed with the international physical activity questionnaire (IPAQ) and their energy intake with a 3-day food diary. Pro-inflammatory cytokines (interleukins, IL-1 and IL-6, and tumor necrosis factor-alpha), erythrocyte sedimentation rate, C-reactive protein, disease activity score-28 and physical function (Health Assessment Questionnaire-HAQ) were also measured. RESULTS BMI correlated inversely with IPAQ (r=-0.511, P=0.000) and positively with energy intake (r=0.331, P=0.016) and HAQ (r=0.133, P=0.042). BF correlated inversely with IPAQ (r=-0.575, P=0.000) and positively with HAQ (r=0.201, P=0.037). Normal weight patients were more physically active compared with those who were either overweight (P=0.006) or obese (P=0.000). Underweight patients consumed significantly fewer calories compared with other patients (P<0.05 in all cases). Cytokines or HAQ did not differ between weight groups. IPAQ was the sole predictor of obesity, whereas energy intake was the sole predictor of underweight. CONCLUSIONS Inflammation does not seem to influence BMI and BF in RA. As in the general population, high levels of habitual physical activity associate with low BMI and BF in RA. Energy intake is a major determinant of being underweight in those who consume fewer calories. Further research is needed to investigate the suitability of exercise and diet modalities, and their effects on the body composition of RA patients.
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Affiliation(s)
- A Stavropoulos-Kalinoglou
- School of Sport, Performing Arts & Leisure, University of Wolverhampton, Walsall, West Midlands, UK.
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Castillero E, Martín AI, López-Menduiña M, Villanúa MA, López-Calderón A. Eicosapentaenoic acid attenuates arthritis-induced muscle wasting acting on atrogin-1 and on myogenic regulatory factors. Am J Physiol Regul Integr Comp Physiol 2009; 297:R1322-31. [PMID: 19741054 DOI: 10.1152/ajpregu.00388.2009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Eicosapentaenoic acid (EPA) is an omega-3 polyunsaturated fatty acid that has anti-inflammatory and anticachectic actions. The aim of this work was to elucidate whether EPA administration is able to prevent an arthritis-induced decrease in body weight and muscle wasting in rats. Arthritis was induced by intradermal injection of Freund's adjuvant; 3 days later, nine rats received 1 g/kg EPA or coconut oil daily. All rats were killed 15 days after adjuvant injection. EPA administration decreased the external signs of arthritis and paw volume as well as liver TNF-alpha mRNA. EPA did not modify arthritis-induced decrease in food intake or body weight gain. However, EPA treatment prevented arthritis-induced increase in muscle TNF-alpha and atrogin-1, whereas it attenuated the decrease in gastrocnemius weight and the increase in MuRF1 mRNA. Arthritis not only decreased myogenic regulatory factors but also increased PCNA, MyoD, and myogenin mRNA in the gastrocnemius. Western blot analysis showed that changes in protein content followed the pattern seen with mRNA. In the control rats, EPA administration increased PCNA and MyoD mRNA and protein. In arthritic rats, EPA did not modify the stimulatory effect of arthritis on these myogenic regulatory factors. The results suggest that in experimental arthritis, in addition to its anti-inflammatory effect, EPA treatment attenuates muscle wasting by decreasing atrogin-1 and MuRF1 gene expression and increasing the transcription factors that regulate myogenesis.
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Affiliation(s)
- Estíbaliz Castillero
- Department of Physiology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Abstract
The goals of dietary therapy in rheumatic diseases are alleviation of under- and malnutrition, inhibition of inflammation, prophylaxis of osteoporosis, as well as recognition and treatment of nutrient sensitivities or intolerances.Inflammation inhibition in these patients is improved by manipulating the omega-3/omega-6 fatty acids ratio in the diet. Reduction of dietary arachidonic acid is recommended. This polyunsaturated fatty acid is the main precursor of pro-inflammatory mediators which interact with chemokines und cytokines. Simultaneously, intake of anti-inflammatory omega-3 fatty acids is increased. Studies have shown that this dietary regimen results in an amelioration of symptoms in patients with inflammatory rheumatic diseases. Dietary therapy in rheumatic diseases is often complicated by concomitant diseases and physical handicaps necessitating interdisciplinary patient care, consisting of rheumatologists, nutritionists, physiotherapists and ergotherapists. Dietary therapy of rheumatic diseases is an adjuvant therapy that should be initiated after a patient is properly diagnosed.
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Abstract
BACKGROUND The question of what potential benefits and harms are associated with certain dietary regimes used in rheumatoid arthritis is an important one for many patients and health care providers. OBJECTIVES To assess the effectiveness and safety of dietary interventions in the treatment of rheumatoid arthritis. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library, issue 1 2008), MEDLINE, EMBASE, AMED, CINAHL and reference lists of relevant articles (up to January 2008), and contacted authors of included articles. SELECTION CRITERIA Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) where the effectiveness of dietary manipulation was evaluated. Dietary supplement studies (including fish oil supplements) were not included. DATA COLLECTION AND ANALYSIS Two authors independently selected trials for inclusion, assessed the internal validity of included trials and extracted data. Investigators were contacted to obtain missing information. MAIN RESULTS Fourteen RCTs and one CCT, with a total of 837 patients, were included. Due to heterogeneity of interventions and outcomes, baseline imbalance and inadequate data reporting, no overall effects were calculated. A single trial with a moderate risk of bias found that fasting, followed by 13 months on a vegetarian diet, may reduce pain (mean difference (MD) on a 0 to 10 scale -1.89, 95% confidence interval (CI) -3.62 to -0.16), but not physical function or morning stiffness immediately after intervention. Another single trial with a moderate risk of bias found that a 12-week Cretan Mediterranean diet may reduce pain (MD on a 0 to 100 scale -14.00, 95% CI -23.6 to -4.37), but not physical function or morning stiffness immediately after intervention. Two trials compared a 4-week elemental diet with an ordinary diet and reported no significant differences in pain, function or stiffness. Due to inadequate data reporting, the effects of vegan and elimination diets are uncertain. When comparing any dietary manipulation with an ordinary diet we found a significantly higher total drop-out of 10% (risk difference (RD) 0.10, 95% CI 0.02 to 0.18), higher treatment-related drop-out of 5% (RD 0.05, 95% CI -0.03 to 0.14) and a significantly higher weight loss (weighted mean difference -3.23, 95% CI -4.79 to -1.67 kg) in the diet groups compared to the control groups. AUTHORS' CONCLUSIONS The effects of dietary manipulation, including vegetarian, Mediterranean, elemental and elimination diets, on rheumatoid arthritis are still uncertain due to the included studies being small, single trials with moderate to high risk of bias. Higher drop-out rates and weight loss in the groups with dietary manipulation indicate that potential adverse effects should not be ignored.
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Affiliation(s)
- Kåre Birger Hagen
- National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vindern, 0319 Oslo, Norway.
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Soeters PB, Reijven PLM, van Bokhorst-de van der Schueren MAE, Schols JMGA, Halfens RJG, Meijers JMM, van Gemert WG. A rational approach to nutritional assessment. Clin Nutr 2008; 27:706-16. [PMID: 18783855 DOI: 10.1016/j.clnu.2008.07.009] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 07/18/2008] [Accepted: 07/23/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Consensus regarding definitions of malnutrition and methods to assess nutritional state is lacking. We propose a definition and its operationalization. METHODS A definition was formulated on the basis of the pathophysiology of malnutrition, while reviewing the metabolic and physiological characteristics of different populations, considered to be malnourished. The definition was operationalized to yield measures to perform nutritional assessment. RESULTS Malnutrition was defined as "a subacute or chronic state of nutrition in which a combination of varying degrees of over- or undernutrition and inflammatory activity has led to a change in body composition and diminished function". Its operationalization led to four elements that may serve as the basis of nutritional assessment: (1) measurement of nutrient balance, (2) measurement of body composition, (3) measurement of inflammatory activity, and (4) measurement of muscle, immune and cognitive function. Most elements measured should be validated with gold standards; normal values should be obtained in different populations. Values obtained in people considered to be at nutritional risk should be related to outcome. CONCLUSION A definition is proposed that reflects the pathophysiology of malnutrition and that, when operationalized, will lead to measures reflecting this pathophysiology. Such an approach may yield comparable and reproducible rates and degrees of malnutrition in populations as well as in individuals.
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Affiliation(s)
- Peter B Soeters
- Faculty of Health, Medicine and Life Sciences, Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
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