ORIGINAL ARTICLENutritional status in patients with rheumatoid arthritis
Introduction
Nutritional status is the result of the balance between the dietary supply and nutritional requirements necessary to go on with physiological activities, to compensate losses and to maintain reserves. Nutritional status is a good predictor of health as shown in the studies that include general population 〚1〛 or disease states 2, 3. The assessment of nutritional status is cheap, effective and available for health professionals.
Long-standing diseases such as chronic infections are known to be associated to some degree of impairment of nutritional status, this condition being associated to a worse vital and functional prognosis 〚4〛. Rheumatoid arthritis (RA), as a chronic inflammatory disease, seems to be a good candidate to include in the list of diseases associated to undernutrition. However, clinicians do not agree about this, probably due to the difficulties of assessing some nutritional parameters in the rheumatic patients. To date, there is not strong evidence of an actual impairment of nutritional status in RA patients 5, 6, 7, 8, 9, 10, 11, 12, 13, 14.
We have undertaken a study in order to analyze the nutritional status in a group of Spanish patients with RA and to establish its relation to some factors such as diet, glucocorticoid therapy and disease activity.
Section snippets
Patients and methods
This study has been made in a tertiary university hospital. In the Rheumatology department, more than 500 patients who fulfill the American College of Rheumatology criteria for RA 〚15〛 are regularly evaluated.
Patients and controls
We classified RA patients by sex and functional class; then, within each of the eight groups, the patients were randomly selected to achieve the sample calculated. In class IV, only five men and 13 women could be included in the study.
At inclusion, none of the patients was hospitalized by a flare of the disease nor by any adverse event related to it. Selected patients were not affected by any potentially consuming diseases as neoplasms, cardiac or respiratory insufficiency and chronic liver or
Results
The demographic and clinical characteristics of the patients are shown in table I. The data about the activity of RA are presented in table II. As expected, there were no differences in the mean age of patients (62.4 ± 11.3 years) and controls (61.9 ± 11.2 years).
The results of the assessment of nutritional status are presented in table III. We did not find differences between RA patients and controls in BMI, TSF and PRE (even when adjusted by serum creatinine). MAC and ALB values were
Discussion
We have analyzed nutritional status in a large group of patients with RA, fully representative of a population of RA followed in a tertiary hospital.
Intrinsic factors associated to RA make nutritional status assessment even more necessary than in the general population. Chronic inflammation increases the metabolic index and nutritional requirements. Physical difficulties to buy and cook the food, temporo-mandibular joint involvement, impairment of mastication and swallowing due to Sjögren’s
References (35)
The role of nutrition in increased morbidity and mortality
Clin Geriatr M
(1995)- et al.
Albumin, transferrin and the thyroxine-binding prealbumin/retino-binding protein (TBPA-RBP) complex in assessment of malnutrition
Clin Chim Acta
(1975) - et al.
Rapid-turnover transport proteins: an index of subclinical protein-energy malnutrition
Lancet
(1979) - et al.
Catabolic effects of high-dose corticosteroids persist despite therapeutic benefit in rheumatoid arthritis
Am J Clin Nutr
(1990) Hormones, cytokines and body composition: can lessons from illness be applied to aging?
J Nutr
(1993)- et al.
Benefits and adverse effects of weight loss: observations from the Framingham study
Ann Intern M
(1993) - et al.
Predicting mortality based on body composition analysis
Ann Surg
(1989) - et al.
Factors predicting death, survival and functional outcome in a prospective study of early rheumatoid disease over fifteen years
Br J Rheumatol
(1993) - et al.
Prevalence of low body mass in rheumatoid arthritis: association with the acute phase response
Ann Rheum Dis
(1997) - et al.
Nutritional status in patients with rheumatoid arthritis
Ann Rheum Dis
(1984)
Nutritional status in rheumatoid arthritis. Effects of disease activity, corticosteroid therapy and functional impairment
S Afr Med J
Mechanisms of depressed delayed type hypersensitivity in rheumatoid arthritis: the role of protein energy malnutrition
Ann Rheum Dis
Nutritional status of Danish rheumatoid arthritis patients and effects of a diet adjusted in energy intake, fish-meal and antioxidants
Scand J Rheumatol
Nutritional status in patients with rheumatoid arthritis
Ann Rheum Dis
Nutritional assessment in rheumatoid arthritis
S Afr Med J
Rheumatoid cachexia: cytokine-driven hypermetabolism accompanying reduced body cell mass in chronic inflammation
J Clin Invest
Undernutrition in rheumatoid arthritis patients with disability
Scand J Rheumatol
Cited by (60)
Impact of disease burden or inflammation on nutritional assessment by the GLIM criteria in female patients with rheumatoid arthritis
2022, Clinical Nutrition ESPENCitation Excerpt :This disease mainly presents with arthritis and bone destruction [2,3], but the inflammation can affect not only joints, but also spread to the whole body. RA patients have lower muscle mass and body cell mass than non-RA patients, even at the same body mass, due to inflammation-induced catabolism of muscle [4–7]. In addition, patients with RA show significantly more gastrointestinal symptoms than those without the disease, and gastrointestinal symptoms are also associated with the effects of medication [8].
Comparison of frailty associated factors between older adult patients with rheumatoid arthritis and community dwellers
2021, Archives of Gerontology and GeriatricsLean and fat mass body composition in rheumatoid arthritis
2021, Medecine des Maladies MetaboliquesAssociation between Overweight/Obesity and Clinical Activity in Rheumatoid Arthritis
2020, Reumatologia ClinicaChanges to Body Composition in Women With Long-Standing Established Rheumatoid Arthritis: Differences by Level of Disease Activity
2020, Journal of Clinical DensitometryCitation Excerpt :A possible explanation is that the disorder of BC resulted from many years of fluctuating but elevated inflammatory activity in combination with low physical activity, which is suggestive of more exuberant rheumatoid cachexia status in this group of patients. These results contrast with the majority of studies that demonstrated parallel low skeletal muscle and increased fat mass in RA with a long disease duration (8–15). Possible explanations for this discrepancy are the longer disease duration (∼18 years) of our patients than that of other populations (∼6–11 years) and the higher disease activity status measured by inflammatory markers (CRP and ESR) in this study.
Rheumatoid arthritis in the elderly: Characteristics and treatment considerations
2020, Autoimmunity ReviewsCitation Excerpt :In addition, anaemia of chronic disease is more frequently encountered in elderly RA patients with GS, which further enhances functional impairment and cognitive dysfunction, leading to further disability and a trend towards increased depression in elderly RA patients [29,33]. Thus, GS in elderly RA contributes to malnutrition, which in turn worsens RA activity and functional outcomes [34]. One could therefore suggest that efficient RA treatment would help to improve physical and mental outcomes in elderly RA patients.