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Blockade of tumour necrosis factor-
in rheumatoid arthritis: effects on components of rheumatoid cachexia
1School of Sport, Performing Arts and Leisure, University of Wolverhampton, Walsall, 2Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russell's Hall Hospital, Dudley, West Midlands, UK and 3Research Institute in Physical Performance and Rehabilitation, Centre for Research and Technology, Thessaly, Trikala, Greece.
Correspondence to: G. S. Metsios, Department of Biomedical Sciences, University of Wolverhampton, Wolverhampton, West Midlands, UK. E-mail: gm{at}wlv.ac.uk
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Abstract |
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Objectives. Rheumatoid arthritis (RA) is accompanied by increased resting energy expenditure (REE) and decreased fat-free mass (FFM). This is referred to as rheumatoid cachexia and is attributed to high levels of tumour necrosis factor-
(TNF-). This study aimed to investigate the effects of anti-TNF- therapy on REE, body composition, physical activity and protein intake in RA patients.
Methods. Twenty RA patients [50% female; age: (mean ± S.D.) 61.1 ± 6.8 yrs; body mass index (BMI): 28.3 ± 3.7 kg/m2] and 12 age–sex–BMI-matched healthy controls were assessed. REE (indirect calorimetry), body composition (bioelectrical impedance), the International Physical Activity Questionnaire (IPAQ), diet, Health Assessment Questionnaire (HAQ), disease activity [disease activity score 28 (DAS28), erythrocyte sedimentation rate (ESR), C-reactive protein] and serum TNF- were measured before (Baseline) as well as 2 weeks (Time-1) and 12 weeks (Time-2) after initiation of anti-TNF- treatment. Controls were only assessed at Baseline.
Results. RA patients had significantly higher REE than controls at Baseline (1799.4 ± 292.0 vs 1502.9 ± 114.5 kcal/day, P = 0.002). Within the RA group, REE increased significantly between Time-1 and Time-2 (P = 0.001) but not between Baseline and Time-2. Sustained significant increases were observed in IPAQ (P = 0.001) and protein intake (P = 0.001). There were no significant changes in FFM or body fat. ESR (P = 0.002), DAS28 (P < 0.001), HAQ (P < 0.001) and TNF- (P = 0.024) improved significantly. Physical activity (P = 0.001) and protein intake (P = 0.024) were significant between-subject factors for the elevation of REE.
Conclusions. After 12 weeks of anti-TNF- therapy, there were significant improvements in disease activity and physical function, as well as physical activity and protein intake, but no significant changes in REE or FFM. There is a need for longer-term studies in this field.
KEY WORDS: Anti-TNF-, Resting energy expenditure, Metabolism, Rheumatoid cachexia, Rheumatoid arthritis, Adipose tissue, Cytokines, Inflammation, Muscle, Biological therapy
Submitted 5 May 2007;
revised version accepted 19 September 2007.
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