The outlook for patients with rheumatoid arthritis (RA) has improved dramatically in the last decade with the advent of combination therapies and novel biologic targeted therapies. Earlier diagnosis and intervention has also resulted in less severe joint damage and a decrease in long-term disability. These advances mean improved quality of life for patients with RA, better health outcomes, and possibly a decreased risk of cardiovascular disease.
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Explore This IssueAugust 2008
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But suppose that even with these improvements, doctors are missing a key clinical factor—a modifiable factor—in the management of RA. Joan Bathon, MD, professor of medicine and deputy director of the division of rheumatology at Johns Hopkins Medical Institution in Baltimore, Md., believes this might, in fact, be the case. That’s why Dr. Bathon and her colleagues are studying the connection between RA and body composition in research funded by the ACR Research and Education Foundation (REF). “We know that RA patients have reduced muscle mass and an increase in fat mass,” says Dr. Bathon. “What we don’t know is what effects this adverse body composition phenotype is having on important health outcomes like cardiovascular disease.”
An increase in body fat, especially visceral fat in the abdomen, may lead to higher rates of cardiovascular disease, including heart attack and stroke, and higher rates of death from these events, says Dr. Bathon. “Too little muscle and too much fat is a double whammy when it comes to a level of function,” she notes. Both are disabling in the general population because having too little muscle makes it difficult for the person to walk, lift objects, and do daily tasks. When the person gains weight from a lack of exercise, his or her daily activities are often further decreased. But, stresses Dr. Bathon, losing weight in these circumstances isn’t the sole answer because a general loss of weight results in a loss of muscle as well. “The key is a combination of weight loss with muscle building,” she says.
Dr. Bathon’s research goal is to investigate the association of adverse body composition in RA patients with overall health outcomes. The results of the analysis will prove important in the clinical practice setting for rheumatologists, she adds.
Dr. Bathon’s latest work on body composition and RA shows how the REF funding is leveraging research that is already underway. Her REF grant is funded through the Within Our Reach: Finding a Cure for Rheumatoid Arthritis campaign, which supports RA research that is not being done anywhere else. The grant is allowing Dr. Bathon and her Johns Hopkins colleague, Jon Giles, MD, assistant professor of medicine there, to go beyond preliminary work funded by the National Institutes of Health. Their research, the Evaluation of Subclinical Cardiovascular Disease and Predictors of Events in Rheumatoid Arthritis (ESCAPE-RA), is a five-year cohort study. The goal of ESCAPE-RA is to identify risk factors for prevalent and progressive subclinical cardiovascular disease in subjects with RA—and it provides the patient population needed to study body composition in RA and relate it to important health outcomes.