MARINA DEL REY, CALIF. — Rheumatoid arthritis patients with well-controlled disease may benefit from performing fat-burning exercises accompanied by resistance training—such as weight lifting—to preserve or even build muscle mass, according to Dr. Joan M. Bathon.
Such a regimen has the potential to address some of the elevated risks for cardiovascular disease found in this population.
A seemingly fit patient with well-controlled rheumatoid arthritis (RA) and a normal body mass index may still have excess body fat, elevated C-reactive protein levels, and increased coronary artery disease risk.
There is no easy way to assess body composition in the office. And even when body mass index is considered, “you don't know how healthy” an RA patient is, said Dr. Bathon, who is professor of medicine and director of the Johns Hopkins Arthritis Center in Baltimore.
The chronic inflammation of RA can waste muscles, and RA-associated disability can promote sedentary lifestyles, which in turn leads to excess fat. Sometimes muscle loss is offset by fat gain, leaving a patient with a normal or even low BMI, yet with an unhealthy body composition, Dr. Bathon explained at a rheumatology seminar that was sponsored by the University of California, Los Angeles.
Appendicular fat correlates with disability, and visceral fat correlates with coronary artery disease, the leading killer of patients with RA, she said.
When patients have well-controlled RA, their high C-reactive protein levels might be coming not from the inflamed joints, but rather from fat deposits, and might signal an increased risk of coronary artery disease.
Dr. Bathon reported supportive data from a published study.
She and her colleagues performed anthropomorphic measurements and dual-energy x-ray absorptiometry (DXA) scanning to assess fat:muscle ratio in 72 men and 117 women with RA and moderate disability. A single CT image of the abdomen in the axial plane was used to assess the amount of visceral fat. The subjects were then matched with 189 healthy controls.
Compared with the healthy controls, women with rheumatoid arthritis who had BMIs below 25 kg/m
Abnormal body composition was associated with increases in joint deformity, self-reported disability scores, C-reactive protein levels, rheumatoid factor seropositivity, and a lack of current treatment with disease-modifying antirheumatic drugs (Arthritis Rheum. 2008;59:807–15).
Disclosures: Dr. Bathon said that she had no relevant conflicts.
A seemingly fit patient with well-controlled rheumatoid arthritis and a normal body mass index may still have a number of heart disease risk factors.
Source ©Luc Ubaghs/iStockphoto.com