Background/Purpose:

Patients with chronic inflammatory rheumatic disease have elevated circulating concentrations of TNF-alpha and other pro-inflammatory cytokines that can modify body composition. Metabolic changes are involved in the onset of cardiovascular disease events. We aimed to evaluate the body composition of patients with Rheumatoid Arthritis (RA) or Spondyloarthritis (SpA) and to assess the effect of TNF-alpha inhibitors (TNFi) on body composition, using systematic review with meta-analysis.

Methods:

PubMed, Cochrane Library, and congress abstracts databases were searched for articles published up to February 2015. Search terms were (“body fat distribution” OR “fat mass” OR “lean mass” OR “body mass component” OR “body composition” OR “body fat distribution”) AND (“rheumatoid arthritis” OR “spondylarthritis” OR “psoriatic arthritis” OR “spondylitis” OR “ankylosing spondylitis”). We restricted the search to adult subjects and body composition using by Dual Energy X-Ray Absorptiometry (DEXA). TNFi effects on body composition were assessed at 6, 12 and 24 months in a systematic review. A meta-analysis comparing DEXA body composition in patients with RA or SpA versus healthy controls was performed using Revman program with an inverse variance model. Heterogeneity was evaluated with Cochran’s Q-test and I²value P-values less than 0.05 were considered as significant.

Results:

Among the 208 articles reviewed, 16 studies met the inclusion criteria. In RA patients, a significant increase in fat mass (+ 1.85 kg, p = 0.02, n= 328, I²= 0%), adiposity (+ 1.7 %, p < 0.00001, n= 219, I²= 0%) and android mass (+ 3.53 kg, p < 0.00001, n= 309, I²= 74%) and a significant decrease in lean mass (- 3.03 kg, p = 0.01, n= 308, I²= 70%), were observed. In SpA patients, a significant but modest increase in fat mass (+ 0.69 kg, p = 0.03, n= 143, I²= 0%) and a significant decrease in lean mass (-3.74 kg, p = 0.03, n= 143, I²= 28%) was observed. TNFi did not modify body composition at 6 and 12 months, whereas at 24 months TNFi were associated with fat mass increase in RA patients (+ 2.32 kg, p = 0.04, I²= 32%) and SpA patients (+1.64 kg, p<0.00001, I²= 0%) and lean mass increase in RA patients (+0.49 kg, p=0.003, I²= 0%) and in SpA patients (+0.9 kg, p<0.0001, I²= 0%).

Conclusion:

Only RA patients have a significant increase of fat mass, that could be related to frequent steroids usage by contrast with SpA. Both RA and SpA patients have a significant decrease of lean mass probably explained by chronic inflammation since it was restored 2 years after initiation of TNFi. Increase of fat mass after TNFi may be explained by an increase in ghrelin.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-tnf-alpha-blockade-on-body-composition-in-inflammatory-rheumatic-disease-systematic-review-with-meta-analysis/