Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients
Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients
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DOI：
10.1093/rheumatology/kew243
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发表时间：
2016-10-01
期刊：
影响因子：
5.5
通讯作者：
O'Brien, Thomas D.
中科院分区：
文献类型：
--
作者：
Lemmey, Andrew B.;Wilkinson, Thomas J.;O'Brien, Thomas D.
客观的。 RA 的典型特征是类风湿性恶病质 [肌肉质量 (MM) 损失和总脂肪质量 (TFM) 过多，尤其是躯干 FM]，这会导致身体残疾。由于类风湿性恶病质是由炎症引起的，因此预计严格控制疾病活动（例如目标治疗（T2T））在减轻炎症方面的成功将有益于身体成分和身体功能。这项横断面研究的目的是评估 T2T 对 RA 患者身体成分的影响并客观评估功能。方法。总共 82 名仅接受 T2T 治疗的 RA 患者与 85 名匹配的久坐健康对照 (HC) 进行了比较。通过 DXA 评估身体成分，用四肢去脂体重作为总 MM 的替代指标。通过膝伸肌力量、握力、30 秒坐站、8 英尺起立行走和 50 英尺步行（反映日常生活活动能力的测试）来评估身体功能。结果。尽管一般治疗效果良好（平均 DAS28 = 2.8，49% 缓解），但与 HC 患者相比，RA 患者的四肢去脂质量按比例减少了约 10%，并且脂肪含量显着增加（约 27%），特别是在躯干部位（约 32%）。与 HC 患者相比，RA 患者的所有功能测量值均较差 24-34%。结论。尽管疾病控制有显着改善（大多数患者达到或接近缓解），但与匹配的 HC 相比，RA 患者的 MM 相对消失和肥胖增加与 T2T 前观察到的相似。此外，目标功能测试的表现与我们小组报告的 T2T 前 RA 患者的结果没有变化。因此，即使在有反应的 RA 患者中，T2T 也不能减轻类风湿性恶病质或改善客观评估的功能。
Objective. RA typically features rheumatoid cachexia [loss of muscle mass (MM) and excessive total fat mass (TFM), especially trunk FM], which contributes to physical disability. Since rheumatoid cachexia is driven by inflammation, it would be anticipated that the success of tight control of disease activity, such as treat-to-target (T2T), in attenuating inflammation would benefit body composition and physical function. This aim of this cross-sectional study was to assess the impact of T2T on body composition and objectively assessed function in RA patients.Methods. A total of 82 RA patients exclusively treated by T2T, were compared with 85 matched sedentary healthy controls (HCs). Body composition was estimated by DXA, with appendicular lean mass the surrogate measure of total MM. Physical function was assessed by knee extensor strength, handgrip strength, 30 s sit-to-stands, 8' up and go, and 50' walk (tests which reflect the ability to perform activities of daily living).Results. Although generally well treated (mean DAS28 = 2.8, with 49% in remission), RA patients had similar to 10% proportionally less appendicular lean mass and were considerably fatter (by similar to 27%), particularly in the trunk (similar to 32%), than HCs. All measures of function were 24-34% poorer in the RA patients relative to HC.Conclusions. Despite marked improvements in disease control (most patients achieving or approaching remission), the relative loss of MM and increased adiposity in RA patients compared with matched HCs was similar to that observed pre-T2T. Additionally, performance of objective function tests was unchanged from that reported by our group for pre-T2T RA patients. Thus T2T, even in responsive RA patients, did not attenuate rheumatoid cachexia or improve objectively assessed function.