The hypotheses for this study are:
- Patients with RA will have a higher total fat mass and lower total lean mass, a higher regional mass (in abdominal visceral and thigh deposits), a higher leptin and resistin and lower adiponectin level even after adjustment for differences in levels of physical activity, and inflammatory markers; and
- Compared with patients with RA with a favorable body composition profile, patients with RA with adverse body composition profile will have a higher prevalence of subclinical atherosclerosis, lower physical function, more disability, and more articular damage.
Future Trials
If these hypotheses are proven, Dr. Bathon says the next step would be a clinical trial that addresses modification of body composition. The exact design for a future study will depend on the primary goal. If the goal is to reduce the risk of cardiovascular events, then modifying body composition to a more favorable phenotype through diet and exercise should be combined with aggressive control of other risk factors, such as a tight control of lipids, glucose, and blood pressure.
There is increasing evidence to suggest that cardiovascular risk in RA patients may also be lowered via tight control of RA disease activity. “These two approaches would have to be combined somehow and such an algorithm would be complex,” she says. “The results of the current study will inform the development of clinical strategies to prevent or reverse adverse body composition, and will set the stage for the conduct of clinical trials to investigate the efficacy of modifying body composition on morbidity and mortality in RA.”
Terry Hartnett is a medical journalist based in Pittsburgh.