• Blockade of tumour necrosis factor-{alpha} in rheumatoid arthritis: effects on components of rheumatoid cachexia

      Metsios, Giorgos S.; Stavropoulos-Kalinoglou, Antonios; Douglas, Karen M. J.; Koutedakis, Yiannis; Nevill, Alan M.; Panoulas, Vasileios F.; Kita, Marina D.; Kitas, George D. (Oxford University Press (Oxford Journals), 2007)
      Objectives. Rheumatoid arthritis (RA) is accompanied by increased resting energy expenditure (REE) and decreased fat-free mass (FFM). This is referred to as rheumatoid cachexia and is attributed to high levels of tumour necrosis factor-{alpha} (TNF-{alpha}). This study aimed to investigate the effects of anti-TNF-{alpha} therapy on REE, body composition, physical activity and protein intake in RA patients. Methods. Twenty RA patients [50% female; age: (mean ± S.D.) 61.1 ± 6.8 yrs; body mass index (BMI): 28.3 ± 3.7 kg/m2] and 12 age–sex–BMI-matched healthy controls were assessed. REE (indirect calorimetry), body composition (bioelectrical impedance), the International Physical Activity Questionnaire (IPAQ), diet, Health Assessment Questionnaire (HAQ), disease activity [disease activity score 28 (DAS28), erythrocyte sedimentation rate (ESR), C-reactive protein] and serum TNF-{alpha} were measured before (Baseline) as well as 2 weeks (Time-1) and 12 weeks (Time-2) after initiation of anti-TNF-{alpha} treatment. Controls were only assessed at Baseline. Results. RA patients had significantly higher REE than controls at Baseline (1799.4 ± 292.0 vs 1502.9 ± 114.5 kcal/day, P = 0.002). Within the RA group, REE increased significantly between Time-1 and Time-2 (P = 0.001) but not between Baseline and Time-2. Sustained significant increases were observed in IPAQ (P = 0.001) and protein intake (P = 0.001). There were no significant changes in FFM or body fat. ESR (P = 0.002), DAS28 (P < 0.001), HAQ (P < 0.001) and TNF-{alpha} (P = 0.024) improved significantly. Physical activity (P = 0.001) and protein intake (P = 0.024) were significant between-subject factors for the elevation of REE. Conclusions. After 12 weeks of anti-TNF-{alpha} therapy, there were significant improvements in disease activity and physical function, as well as physical activity and protein intake, but no significant changes in REE or FFM. There is a need for longer-term studies in this field.
    • Rheumatoid arthritis, cardiovascular disease and physical exercise: a systematic review

      Metsios, Giorgos S.; Stavropoulos-Kalinoglou, Antonios; Veldhuijzen van Zanten, J.J.C.S.; Treharne, G.J.; Panoulas, Vasileios F.; Douglas, Karen M. J.; Koutedakis, Yiannis; Kitas, George D. (Oxford University Press (Oxford Journals), 2008)
      This systematic review investigates the effectiveness of exercise interventions in improving disease-related characteristics in patients with rheumatoid arthritis (RA). It also provides suggestions for exercise programmes suitable for improving the cardiovascular profile of RA patients and proposes areas for future research in the field. Six databases (Medline, Cochrane Library, CINAHL, Google Scholar, EMBASE and PEDro) were searched to identify publications from 1974 to December 2006 regarding RA and exercise interventions. The quality of the studies included was determined by using the Jadad scale. Initial searches identified 1342 articles from which 40 met the inclusion criteria. No studies were found investigating exercise interventions in relation to cardiovascular disease in RA. There is strong evidence suggesting that exercise from low to high intensity of various modes is effective in improving disease-related characteristics and functional ability in RA patients. Future studies are required to investigate the effects of exercise in improving the cardiovascular status of this patient population.