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Cachexia in patients with rheumatoid arthritis: a cohort study

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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.

Key Points

• Rheumatoid cachexia is common in RA patients.

• Classical cachexia is not often in RA patients.

• Disease activity and use of biologic therapies are associated with changes on body composition and physical function.

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Acknowledgments

We thank the Coordination for the Improvement of Higher Level Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES) and the Rio Grande do Sul State Research Foundation (Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul, FAPERGS) for granting scholarships to the students that contributed to this study. We thank the HCPA Department of Rheumatology and Biostatistics Service for scientific support. Financial support was provided by the HCPA Research and Events Incentive Fund (Fundo de Incentivo à Pesquisa e Eventos, FIPE), the Research Support Fund of the Rio Grande do Sul Society of Rheumatology (Fundo de Apoio à Pesquisa da Sociedade de Reumatologia do Rio Grande do Sul), and National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq).

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Authors and Affiliations

  1. Hospital de Clínicas de Porto Alegre, Laboratório de Doenças Autoimunes, Porto Alegre, Brazil

    Rafaela CE Santo, Jordana MS Silva, Ana Laura D Moro, Eduarda C Freitas, Bárbara J Bartikoski, Nicole PB Andrade, Penélope E Palominos, Vanessa Hax, Claiton V Brenol, Rafael MS Chakr & Ricardo M Xavier

  2. Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Brazil

    Rafaela CE Santo, Jordana MS Silva, Ana Laura D Moro, Eduarda C Freitas, Bárbara J Bartikoski, Nicole PB Andrade, Penélope E Palominos, Vanessa Hax, Claiton V Brenol, Rafael MS Chakr & Ricardo M Xavier

  3. Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, Brazil

    Rafaela CE Santo, Jordana MS Silva, Ana Laura D Moro, Eduarda C Freitas, Bárbara J Bartikoski, Nicole PB Andrade, Penélope E Palominos, Vanessa Hax, Claiton V Brenol, Rafael MS Chakr & Ricardo M Xavier

  4. Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil

    Priscila S Lora

  5. Hospital de Clínicas de Porto Alegre, Serviço de Endocrinologia, Porto Alegre, Brazil

    Tayane M Fighera & Poli Mara Spritzer

  6. Universidade La Salle, Canoas, Brazil

    Lidiane I Filippin

  7. University of Pennsylvania, Philadelphia, PA, USA

    Joshua F Baker

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  1. Rafaela CE Santo
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  2. Jordana MS Silva
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Correspondence to Rafaela CE Santo.

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Santo, R.C., Silva, J.M., Lora, P.S. et al. Cachexia in patients with rheumatoid arthritis: a cohort study. Clin Rheumatol 39, 3603–3613 (2020). https://doi.org/10.1007/s10067-020-05119-y

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