Rheumatoid cachexia in early rheumatoid arthritis: prevalence and associated variables

Figures & data

Figure 1. Flowchart of the inclusion and exclusion process. RA, rheumatoid arthritis.

Table 1. Characteristics of 87 patients with early rheumatoid arthritis (RA) and subgroups with and without rheumatoid cachexia (RC).†

Characteristic	All RA	With RC	Without RC	With RC vs without RC p-value
Patients	87 (100)	21 (24) (7)†	66 (76)	–
		28 (32) (8)‡	59 (68)
Age (years)	60 (47–68)	58 (48–67)	6 0 (47–68)	0.8
Disease duration (months)	15 (13–19)	15 (12–17)	15 (13–20)	0.3
ACPA positive	57 (66)	15 (71)	42 (64)	0.5
RF positive	67 (77)	16 (76)	51 (77)	0.9
DAS28 score at inclusion (n = 86)	2.7 (1.6–3.6)	2.2 (1.5–3.2)	2.8 (1.9–3.6)	0.1
CRP at inclusion (mmol/L)	2.2 (0.9–4.9)	2.1 (1.0–5.0)	2.5 (0.9–4.8)	0.8
ESR (at time of diagnosis (mm/h) (n = 86)	25.0 (11.0–40.8)	34.0 (21.0–61.0)	24.0 (10.5–37.5)	0.08
ESR (at inclusion (mm/h) (n = 86)	12.0 (6.0–19.0)	14.0 (6.5–21.5)	11.5 (6.0–19.2)	0.7
HAQ score (n = 86)	0.38 (0.0–0.38)	0.38 (0.0–0.75)	0.38 (0–0.82)	0.9
DMARDs	81 (93)	19 (90)	62 (94)	0.6
Biological agents	12 (14)	1 (5)	11 (17)	0.2
Corticosteroids	23 (26)	5 (24)	18 (27)	0.8
Response to treatment (n = 83)	65 (78)	19 (95)	46 (73)	0.04*
Aerobic capacity (L O2/min) (n = 67)	2.2 (1.9–2.7)	2.0 (1.5–2.6)	2.3 (2.0–2.8)	0.04*
Aerobic capacity (mL O2/kg/min) (n = 67)	29.7 (26.1–37.3)	28.3 (23.6–37.2)	30.2 (26.1–37.3)	0.7
LPA (h/day) (n = 82)	6.8 (5.4–7.8)	6.2 (4.0–7.7)	6.9 (5.7–8.1)	0.1
MVPA (h/day) (n = 79)	0.7 (0.2–1.4)	1.0 (0.4–1.6)	0.5 (0.2–1.1)	0.1
WC (cm)	95 ± 15	90 (80–96)	97 (87–106)	0.01*
BMI (kg/m^2)	26.2 (23.5–30.4)	23.5 (21.3–26.4)	26.7 (24.1–31.3)	< 0.001*
Body weight (kg)	74.3 (65.7–85.5)	66.3 (59.4–75.3)	77.1 (66.5–88.4)	0.002*
FFMI (kg/m^2)	16.2 (15.2–18.1)	13.9 (13.6–15.8)	16.7 (15.7–18.4)	< 0.001*
FMI (kg/m^2)	9.7 (7.6–13.6)	8.8 (7.1–11.5)	9.9 (7.8–14.7)	0.2
Cholesterol (mmol/L) (n = 86)	5.0 ± 1.0	5.0 (4.2–6.0)	5.1 (4.1–5.8)	0.6
HDL (mmol/L) (n = 86)	1.5 ± 0.5	1.7 ± 0.55	1.46 ± 0.46	0.06
Current smoker	11 (13)	3 (14)	8 (11)	0.8
10 year CVD mortality risk (20) (%) (n = 86)	1.5 (0.0–3.0)	1.5 (0.0–3.8)	1.5 (0.0–3.0)	0.7
Currently working	46 (53)	10 (48)	36 (55)	0.6
Higher education	41 (47)	11 (52)	30 (45)	0.6

Data are presented as n (%), median (Q1–Q3), or mean ± sd.

RC defined according to †Engvall et al (7): fat-free mass index (FFMI) < 10th percentile and fat mass index (FMI) > 25th percentile; or ‡Elkan et al (8): FFMI < 25th percentile and FMI > 50th percentile. All patients who were classified as moderate or good responders to treatment were grouped as responders; the remaining patients were grouped as non-responders.

*Significant difference (p < 0.05).

ACPA, anti-citrullinated protein antibodies; RF, rheumatoid factor; DAS28, Disease Activity Score in 28 joints; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; HAQ, Health Assessment Questionnaire; DMARD, disease-modifying anti-rheumatic drug; LPA, low-intensity physical activity; MVPA, moderate- to vigorous-physical activity; WC, waist circumference; BMI, body mass index; FFMI, fat-free mass index; FMI, fat mass index; HDL, high-density lipoprotein; CVD, cardiovascular disease.

Table 2. Univariate logistic regression results for 87 patients with early rheumatoid arthritis, with rheumatoid cachexia (RC)† as the dependent variable.

Variable	OR	95% CI
Age, per year	0.99	0.96–1.03
Gender, women = 1	0.76	0.26–2.16
Disease duration, per month	0.95	0.84–1.07
Response to treatment, yes = 1	7.02	0.87–56.6
DAS28 at inclusion, per unit	0.71	0.43–1.06
DAS28-AUC, per unit	0.98	0.95–1.001
CRP at inclusion, per mg/L	0.95	0.85–1.07
CRP-AUC, per unit	1.001	0.99–1.01
ESR at time of diagnosis, per mm/h (n = 86)	1.02	1.00–1.05*§
ESR at inclusion, per mm/h (n = 86)	1.02	0.97–1.07
ESR-AUC, per unit (n = 86)	1.002	0.99–1.01
HAQ, per unit	0.79	0.27–2.30
DMARD users, yes = 1	0.61	0.10–3.61
Biological agent users, yes = 1	0.25	0.03–2.06
Corticosteroid users, yes = 1	0.83	0.27–2.61
Aerobic capacity, per L O2/min (n = 67)	0.28	0.09–0.89*§
Aerobic capacity, per mL O2/kg/min (n = 67)	0.98	0.92–1.05
LPA, per h/day (n = 82)	0.77	0.60–0.99*§
MVPA, per h/day (n = 79)	1.50	0.82–2.76
BMI, per kg/m^2	0.78	0.70–0.92*§
WC, per cm	0.96	0.92–0.99*§
Body weight, per kg	0.94	0.90–0.98*§
Current smoker, yes = 1	1.40	0.33–6.00

Data are shown as the odds ratio (OR) and 95% confidence interval (CI).

†RC defined according to Engvall et al (7): fat-free mass index (FFMI) < 10th percentile and fat mass index (FMI) > 25th percentile. All patients who were classified as moderate or good responders to treatment were grouped as responders, the remaining patients were grouped as non-responders (28).

DAS28, Disease Activity Score in 28 joints; AUC, area under the curve; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; HAQ, Health Assessment Questionnaire; DMARD, disease-modifying anti-rheumatic drug; LPA, low-intensity physical activity; MVPA, moderate- to vigorous-intensity physical activity; BMI, body mass index; WC, waist circumference.

*p < 0.05 in the univariate analysis; §p < 0.05 in the adjusted analysis.

Table 3. Logistic regression model results for patients with early rheumatoid arthritis, with rheumatoid cachexia.†

Model	1	2	3	4
Age, per year	0.99 (0.96–1.03)	0.98 (0.94–1.01)	0.93* (0.88–0.99)	0.93* (0.87–0.99)
Gender, women = 1	0.71 (0.24–2.10)	0.70 (0.22–2.19)	0.17 (0.03–1.05)	0.10* (0.01–0.72)
ESR, at time of diagnosis, per mm/h	–	1.03* (1.01–1.05)	1.03 (0.99–1.06)	1.04* (1.00–1.08)
Aerobic capacity, per L O2/min	–	–	0.09* (0.02–0.49)	0.15* (0.03–0.77)
Body weight, per kg	–	–	–	0.90* (0.85–0.98)
Nagelkerke R^2	0.01	0.11	0.32	0.48
Hosmer and Lemeshow test	0.29	0.22	0.09	0.68
Number of observations	87	87	67	67

Data are shown as odds ratio (95% confidence interval).

†RC defined according to Engvall et al (7): fat-free mass index (FFMI) < 10th percentile and fat mass index (FMI) > 25th percentile.

ESR, erythrocyte sedimentation rate.

*p < 0.05.

Engvall IL, Elkan AC, Tengstrand B, Cederholm T, Brismar K, Hafstrom I. Cachexia in rheumatoid arthritis is associated with inflammatory activity, physical disability, and low bioavailable insulin-like growth factor. Scand J Rheumatol 2008;37:321–8.

 PubMed Web of Science ®Google Scholar

Elkan AC, Håkansson N, Frostegård J, Cederholm T, Hafström I. Rheumatoid cachexia is associated with dyslipidemia and low levels of atheroprotective natural antibodies against phosphorylcholine but not with dietary fat in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther 2009;11:R37.

 PubMed Web of Science ®Google Scholar

Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987–1003.

 PubMed Web of Science ®Google Scholar