Background Early change in body composition is one of the risk factors of CVD in rheumatoid arthritis (RA). These changes have been atributed to inflammation and decreased physical activity. Glucocorticosteroids (GCS) reduces inflammation but may influence body composition. There is limited information about the effects of low-dose GCS on body composition in early RA.

Objectives The aim of the study was to assess the presence of altered body composition in patients with early rheumatoid arthritis (eRA) and to determine whether low-dose prednisone affects body composition.

Methods 65 consecutive eRA patients (49 women) aged 61±14 years were assessed at the time of diagnosis and after 12 months of treatment. All the patients had been treated with methotrexate (target dose 25–30mg/week) and tapered doses of prednisone (mean dose 4.8±3.4 mg/day). Disease activity score (DAS28), Health Assesment Questionnaire (HAQ), body mass index (BMI), waist/hip ratio, comorbidities, physical activity and smoking were recorded. Total and regional lean mass and fat mass were measured with dual energy X-ray absorptiometry (DXA). DXA measures were repeated after 12 months in 34 patients (24 women) and compared with baseline data.

Results At baseline fat free mass index (FFMI; kg/m²) was below the 10th percentile of a reference population in 32% of the women and 25% of the men. Reduced FFMI correlated with baseline ESR. Fat mass index (FMI) was above 90th percentile in 28% of the women and 42% of the men. Fat mass index (FMI;kg/m²) correlated with HAQ, age and femoral BMD in women. After 12 months FFMI and FMI did not change significantly. There was no correlation between prednisone doses and the duration of prednisone treatment and changes in regional lean mass and fat mass. The decrase of FFMI (in 16 patients) was associated with higher mean ESR and lower vitamin D3 serum concentration.

Conclusions Low FFMI was common in patients with eRA. The treatment with low-dose glucocorticosteroids did not influence altered body composition during the first year of eRA therapy.

References

1. Book C, Karlsson MK, Nilsson JA et al. Changes in body composition after 2 years with rheumatoid arthritis. Scandinavian Journal of Rheumatology 2011(40:2); 95–100.

2. Schtz Y, Kyle UUG, Pichard C. Fat-free mass index and fat mass index percentiles in Caucasians aged 18–98 y. International Journal of Obesity 2002(26);953–960.

3. Engvall IL, Brisman K, Hafström I et al. Treatment with low-dose prednisolone is associated with altered body composition but no difference in bone mineral density in rheumatoid atrhritis patients: a controlled cross-sectional study. Scandinavian Journal of Rheumatology 2010(40:3)161–168.

References

Disclosure of Interest None declared