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Santo RC, Silva JM, Lora PS, Moro ALD, Freitas EC, Bartikoski BJ, Andrade NP, Palominos PE, Hax V, Fighera TM, Spritzer PM, Brenol CV, Chakr RM, Filippin LI, Baker JF, Xavier RM. Cachexia in patients with rheumatoid arthritis: a cohort study. Clin Rheumatol 2020; 39:3603-3613. [PMID: 32447598 DOI: 10.1007/s10067-020-05119-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an inflammatory disease that leads to altered body composition. The loss of lean mass with a preservation or increase in fat mass has been termed rheumatoid cachexia (RC), to contrast with classic cachexia, which is characterized by severe weight loss. There are limited data on the prevalence and progression of cachexia in RA over time, as well as on associated factors. Our aim was to determine the prevalence of cachexia and to determine associations with potential factors. METHODS This prospective cohort study recruited consecutively patients diagnosed with RA and followed for 1 year. The assessments were performed: clinical features, body composition, and physical function. RC and classic cachexia were assessed by several established diagnostic criteria. The pairwise Student's t test, Chi-square test, and GEE were performed (accepted at p ≤ 0.05). RESULTS Of 90 patients recruited, 81 completed the study. Most patients were women (88.9%), and the mean age was 56.5 ± 7.3 years. At baseline, the median DAS28-CRP was 3.0 (IQR, 1.0-3.0), 13.3-30.0% of the included patients had RC, while none met criteria for classic cachexia. The prevalence of cachexia did not change after 12 months. Disease activity status and treatment with biologic disease-modifying antirheumatic drugs were significantly associated with changes on body composition and physical function (p < 0.05). CONCLUSIONS In this cohort, RC was common, while classic cachexia was absent. Disease activity and use of biologic therapies were associated with changes on body composition and physical function, underscoring the importance of aiming for remission when treating RA.
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Affiliation(s)
- Rafaela Ce Santo
- Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil.
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil.
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil.
| | - Jordana Ms Silva
- Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil
| | | | - Ana Laura D Moro
- Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil
| | - Eduarda C Freitas
- Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil
| | - Bárbara J Bartikoski
- Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil
| | - Nicole Pb Andrade
- Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil
| | - Penélope E Palominos
- Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil
| | - Vanessa Hax
- Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil
| | - Tayane M Fighera
- Hospital de Clínicas de Porto Alegre, Serviço de Endocrinologia, Porto Alegre, Brazil
| | - Poli Mara Spritzer
- Hospital de Clínicas de Porto Alegre, Serviço de Endocrinologia, Porto Alegre, Brazil
| | - Claiton V Brenol
- Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil
| | - Rafael Ms Chakr
- Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil
| | | | | | - Ricardo M Xavier
- Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil
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Santo RC, Fernandes KZ, Lora PS, Filippin LI, Xavier RM. Prevalence of rheumatoid cachexia in rheumatoid arthritis: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2018; 9:816-825. [PMID: 30133186 PMCID: PMC6204596 DOI: 10.1002/jcsm.12320] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/18/2018] [Accepted: 05/22/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Low muscle mass occurs in patients with rheumatoid arthritis without weight loss; this condition is referred as rheumatoid cachexia. The aim of the current study was to perform a systematic review with meta-analysis to determine the rheumatoid cachexia prevalence. METHODS A systematic review with meta-analysis of observational studies published in English, between 1994 and 2016, was conducted using MEDLINE (via PubMed) and other relevant sources. Search strategies were based on pre-defined keywords and medical subject headings. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was used to estimate the prevalence, and because studies reported different methods and criteria to estimate body composition and prevalence of rheumatoid cachexia, subgroup analyses were performed. Meta-regression adjusted for the 28-joint disease activity score and disease duration (years) was performed (significance level at P ≤ 0.05). RESULTS Of 136 full articles (one duplicate publication) screened for inclusion in the study, eight were included. The estimated overall prevalence of rheumatoid cachexia was 19% [95% confidence interval (CI) 07-33%]. This prevalence was 29% (95% CI 15-46%) when body composition was measured by dual-energy X-ray absorptiometry. When the diagnostic criteria were fat-free mass index below the 10th percentile and fat mass index above the 25th percentile, rheumatoid cachexia prevalence was 32% (95% CI 14-52%). The 28-joint disease activity score and disease duration had no influence on the estimated prevalence of rheumatoid cachexia (P > 0.05). Most studies were rated as having moderate methodological quality. CONCLUSIONS Meta-analysis showed a prevalence of rheumatoid cachexia of 15-32%, according to different criteria, demonstrating that this condition is a frequent comorbidity of rheumatoid arthritis. To better understand its clinical impact, more studies using standardized definitions and prospective evaluations are urgently needed.
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Affiliation(s)
- Rafaela C.E. Santo
- Hospital de Clínicas de Porto AlegreLaboratório de Doenças AutoimunesPorto AlegreBrazil
- Universidade Federal do Rio Grande do SulFaculdade de MedicinaPorto AlegreBrazil
- Hospital de Clínicas de Porto AlegreServiço de ReumatologiaPorto AlegreBrazil
| | - Kevin Z. Fernandes
- Hospital de Clínicas de Porto AlegreLaboratório de Doenças AutoimunesPorto AlegreBrazil
- Centro Universitário Metodista IPAPorto AlegreBrazil
| | - Priscila S. Lora
- Hospital de Clínicas de Porto AlegreLaboratório de Doenças AutoimunesPorto AlegreBrazil
- Universidade do Vale do Rio dos SinosSão LeopoldoBrazil
| | - Lidiane I. Filippin
- Hospital de Clínicas de Porto AlegreLaboratório de Doenças AutoimunesPorto AlegreBrazil
- Universidade La SalleCanoasBrazil
| | - Ricardo M. Xavier
- Hospital de Clínicas de Porto AlegreLaboratório de Doenças AutoimunesPorto AlegreBrazil
- Universidade Federal do Rio Grande do SulFaculdade de MedicinaPorto AlegreBrazil
- Hospital de Clínicas de Porto AlegreServiço de ReumatologiaPorto AlegreBrazil
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Alabarse PV, Lora PS, Silva JM, Santo RC, Freitas EC, de Oliveira MS, Almeida AS, Immig M, Teixeira VO, Filippin LI, Xavier RM. Collagen-induced arthritis as an animal model of rheumatoid cachexia. J Cachexia Sarcopenia Muscle 2018; 9:603-612. [PMID: 29575818 PMCID: PMC5989855 DOI: 10.1002/jcsm.12280] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/21/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis is characterized by chronic polyarticular synovitis and presents systemic changes that impact quality of life, such as impaired muscle function, seen in up to 66% of the patients. This can progress to severely debilitating state known as rheumatoid cachexia-without loss of fat mass and body weight-for which there is little consensus in terms of diagnosis or treatment. This study aims to evaluate whether the collagen-induced arthritis (CIA) animal model also develops clinical and functional features characteristic of rheumatoid cachexia. METHODS Male DBA1/J mice were randomly divided into 2 groups: healthy animals (CO, n = 11) and CIA animals (n = 13). The clinical score and edema size, animal weight and food intake, free exploratory locomotion, grip strength, and endurance exercise performance were tested 0, 18, 35, 45, 55, and 65 days after disease induction. After euthanasia, several organs, visceral and brown fat, and muscles were dissected and weighed. Muscles were used to assess myofiber diameter. Ankle joint was used to assess arthritis severity by histological score. Statistical analysis were performed using one-way and two-way analyses of variance followed by Tukey's and Bonferroni's test or t-test of Pearson and statistical difference were assumed for a P value under 0.05. RESULTS The CIA had significantly higher arthritis scores and larger hind paw edema volumes than CO. The CIA had decreased endurance exercise performance total time (fatigue; 23, 22, 24, and 21% at 35, 45, 55, and 65 days, respectively), grip strength (27, 55, 63, 60, and 66% at 25, 35, 45, 55, and 65 days, respectively), free locomotion (43, 57, 59, and 66% at 35, 45, 55, and 65 days, respectively), and tibialis anterior and gastrocnemius muscle weight (25 and 24%, respectively) compared with CO. Sarcoplasmic ratios were also reduced in CIA (TA: 23 and GA: 22% less sarcoplasmic ratio), confirming the atrophy of skeletal muscle mass in these animals than in CO. Myofiber diameter was also reduced 45% in TA and 41% in GA in CIA when compared with the CO. Visceral and brown fat were lighter in CIA (54 and 39%, respectively) than CO group. CONCLUSIONS The CIA model is a valid experimental model for rheumatoid cachexia given that the clinical changes observed were similar to those described in patients with rheumatoid arthritis.
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Affiliation(s)
- Paulo V.G. Alabarse
- Laboratório de Doenças AutoimunesHospital de Clínicas de Porto AlegrePorto AlegreBrazil
- Faculdade de MedicinaUniversidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2350Porto Alegre90035‐003Brazil
| | - Priscila S. Lora
- Laboratório de Doenças AutoimunesHospital de Clínicas de Porto AlegrePorto AlegreBrazil
- Universidade do Vale do Rio dos SinosSão LeopoldoBrazil
| | - Jordana M.S. Silva
- Laboratório de Doenças AutoimunesHospital de Clínicas de Porto AlegrePorto AlegreBrazil
- Faculdade de MedicinaUniversidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2350Porto Alegre90035‐003Brazil
| | - Rafaela C.E. Santo
- Laboratório de Doenças AutoimunesHospital de Clínicas de Porto AlegrePorto AlegreBrazil
- Faculdade de MedicinaUniversidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2350Porto Alegre90035‐003Brazil
| | - Eduarda C. Freitas
- Laboratório de Doenças AutoimunesHospital de Clínicas de Porto AlegrePorto AlegreBrazil
- Faculdade de MedicinaUniversidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2350Porto Alegre90035‐003Brazil
| | - Mayara S. de Oliveira
- Laboratório de Doenças AutoimunesHospital de Clínicas de Porto AlegrePorto AlegreBrazil
- Faculdade de MedicinaUniversidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2350Porto Alegre90035‐003Brazil
| | - Andrelise S. Almeida
- Laboratório de Doenças AutoimunesHospital de Clínicas de Porto AlegrePorto AlegreBrazil
- Faculdade de BiomedicinaUniversidade do Vale do Rio dos SinosSão LeopoldoBrazil
| | - Mônica Immig
- Laboratório de Doenças AutoimunesHospital de Clínicas de Porto AlegrePorto AlegreBrazil
- Faculdade de BiomedicinaUniversidade do Vale do Rio dos SinosSão LeopoldoBrazil
| | - Vivian O.N. Teixeira
- Laboratório de Doenças AutoimunesHospital de Clínicas de Porto AlegrePorto AlegreBrazil
- Faculdade de MedicinaUniversidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2350Porto Alegre90035‐003Brazil
| | - Lidiane I. Filippin
- Laboratório de Doenças AutoimunesHospital de Clínicas de Porto AlegrePorto AlegreBrazil
- Universidade La SalleCanoasBrazil
| | - Ricardo M. Xavier
- Laboratório de Doenças AutoimunesHospital de Clínicas de Porto AlegrePorto AlegreBrazil
- Faculdade de MedicinaUniversidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2350Porto Alegre90035‐003Brazil
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Urbano PC, Soccol VT, Teixeira VN, Oliveira PG, Filippin LI, Bonat WH, de Oliveira C, Rossi GR, Xavier RM, Azevedo VF. Effect of pegylated phosphatidylserine-containing liposomes in experimental chronic arthritis. BMC Pharmacol Toxicol 2015; 16:24. [PMID: 26392267 PMCID: PMC4578330 DOI: 10.1186/s40360-015-0022-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 08/21/2015] [Indexed: 11/29/2022] Open
Abstract
Background Phosphatidylserine-containing liposomes (PSL) have been shown to reduce inflammation in experimental models of acute arthritis, by mimicking the apoptotic process. The aim of this study was to evaluate the effect of pegylated PSL (PEG-PSL) on chronic inflammation of collagen induced arthritis (CIA) in DBA/1J mice. Methods CIA was induced in 24 DBA/1J mice (n = 6/group), which were divided into control (0.9 % saline) or treated with PEG-PSL (5, 10 and 15 mg/kg/day, subcutaneously for 20 days). Clinical score, limb histology and measurement of cytokines in knee joints of animals by ELISA and cytometric bead array (CBA) were evaluated. The in vitro study employed macrophage cultures stimulated with 100 ng/ml of LPS plus 10 ng/ml of PMA and treated with 100 μM PEG-PSL. Results Resolution of the disease in vivo and the inflammatory process in vitro were not observed. PEG-PSL, in doses of 10 and 15 mg/kg, were not shown to reduce the score of the disease in animals, whereas with the dose of 5 mg/kg, the animals did not show the advanced stage of the disease when compared to the controls. The PEG- PSL 5, 10 and 15 mg/kg treatment groups did not show significant reduction of TNF-α, IL-1β, IL-6, IL-2 and IFN-γ when compared to the controls. Disease incidence and animal weights were not affected by treatment. Regarding the paw histology, PEG-PSL did not yield any reductions in the infiltrating mononuclear, synovial hyperplasia, extension of pannus formation, synovial fibrosis, erosion of cartilage, bone erosion or cartilage degradation. The concentration of 100 μM of PEG-PSL has not been shown to reduce inflammation induced by LPS/PMA in the in vitro study. Treated groups did not show any reduction in inflammatory cytokines in the knee joints of animals affected by the disease compared to the control, although there were higher concentrations of TGF-β1 in all experimental groups. Conclusion The experimental model showed an expression of severe arthritis after the booster. TGF-β1 as well other pro inflammatory cytokines were presented in high concentrations in all groups. PEG-PSL had no impact on the clinical score, the histopathology from tibial-tarsal joints or the production of cytokines in the knee joints. Other alternatives such as dosage, route of administration, and as an adjunct to a drug already on the market, should be evaluated to support the use of PEG-PSL as a new therapeutic tool in inflammatory diseases.
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Affiliation(s)
- Paulo Cm Urbano
- Biotechnology and Bioprocess Engineering, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
| | - Vanete T Soccol
- Biotechnology and Bioprocess Engineering, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
| | - Vivian N Teixeira
- Rheumatology Department, Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brazil.
| | - Patrícia G Oliveira
- Rheumatology Department, Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brazil.
| | - Lidiane I Filippin
- Rheumatology Department, Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brazil.
| | - Wagner H Bonat
- Statistical Laboratory (LABEST), Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil.
| | - Carolina de Oliveira
- Department of Cell Biology, Research Laboratory of Inflammatory Cells and Neoplastic, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil.
| | - Gustavo R Rossi
- Department of Cell Biology, Research Laboratory of Inflammatory Cells and Neoplastic, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil.
| | - Ricardo M Xavier
- Rheumatology Department, Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brazil.
| | - Valderilio F Azevedo
- Rheumatology Service and Internal Medicine, Hospital de Clínicas de Curitiba, Universidade Federal do Paraná (UFPR), Rua Alvaro Alvin, 224 casa 18, Curitiba, Paraná, 80440080, Brazil.
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Abstract
Reactive oxygen species (ROS) are produced mainly during oxidative phosphorylation and by activated phagocytic cells during oxidative burst. The excessive production of ROS can damage lipids, protein, membrane and nucleic acids. They also serve as important intracellular signalling that enhances the inflammatory response. Many studies have demonstrated a role of ROS in the pathogenesis of inflammatory chronic arthropathies, such as rheumatoid arthritis. It is known that ROS can function as a second messenger to activate nuclear factor kappa-B, which orchestrates the expression of a spectrum of genes involved in the inflammatory response. Therefore, an understanding of the complex interactions between these pathways might be useful for the development of novel therapeutic strategies for rheumatoid arthritis.
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Affiliation(s)
- L I Filippin
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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