Timing and causes of rheumatoid cachexia in RA patients
Research type
Research Study
Full title
At what stage of disease do adverse changes in body composition (‘rheumatoid cachexia’) occur in rheumatoid arthritis patients? Are these changes exacerbated by high-dose intra-muscular corticosteroid injection given to treat high disease activity?
IRAS ID
212614
Contact name
Yasmeen Ahmad
Contact email
Sponsor organisation
University of Liverpool
Duration of Study in the UK
2 years, 4 months, 31 days
Research summary
Rheumatoid arthritis (RA) is characterised by muscle loss and elevated fat mass (FM), particularly trunk FM, which contributes to reduced strength, impaired physical function, and increased risk of other diseases (co-morbidities) including cardio-vascular disease and diabetes. These adverse changes in body composition, termed ‘rheumatoid cachexia’ (RC), are driven by inflammation, and primarily occur when disease activity (inflammation) is uncontrolled. Unfortunately, although current drug treatments for RA successfully reduce inflammation and disease activity, they fail to reverse RC and thus do not restore physical function or reduce co-morbidity risk.
Preliminary findings by our group suggest that RC commences prior to diagnosis. Study/Question 1 ('Is rheumatoid cachexia present at diagnosis of RA?') will confirm whether RC is apparent at diagnosis, which, if it is, would justify the immediate commencement of interventions aimed at restoring body composition, thus attenuating the disability and elevated co-morbidity risk of RA.
In newly diagnosed RA (ndRA), short term glucocorticoids (GC) are used to rapidly improve symptoms and a single high-dose intramuscular (IM) corticosteroid (CS) injection is a common method to control RA at initial initiation of RA management. In the course of their treatment most RA patients will receive at least one IM CS injection. Whilst very effective in rapidly subduing inflammation, results from our pilot study (n=8) indicate that this NICE recommended, standard treatment exacerbates muscle loss and trunk FM gain, and thereby contributes to disability and co-morbidity risk. The aim of Study/Question 2 ('Does intra-muscular corticosteroid injection treatment for high RA disease activity exacerbate rheumatoid cachexia?') is to establish the body composition effects of a single IM CS injection in ndRA patients in a clinic-based study. Patients will undergo body composition assessment on the injection day, 6 weeks, 6 months and at 1 year.
REC name
Wales REC 5
REC reference
17/WA/0256
Date of REC Opinion
8 Sep 2017
REC opinion
Further Information Favourable Opinion