Impact of Rheumatoid Arthritis research acknowledged in the US

A paper written by Prof. Andrew Lemmey (School of Sports Health & Exercise Sciences) titled “Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients”was adjudged the most popular article on rheumatoid arthritis in 2016 by Rheumatology Advisor (U.S. weekly newsletter which cherry-picks and summarises articles from all the major international rheumatology journals). This follows on from another accolade from Rheumatology in June when it was selected as the most interesting in press paper for a podcast.  

Loss of muscle and increased fat mass are characteristics of rheumatoid arthritis (RA).  These adverse changes in body composition markedly impair physical function (i.e. increase disability) and increase cardiovascular disease risk; the main cause of death of these patients.  Prof Lemmey’s research found that RA patients ‘successfully’ treated by current methods (half were in ‘remission’) remained significantly muscle wasted and fatter than age- and sex-matched healthy sedentary individuals. They also struggled much more with daily tasks with the RA patients only performing to 2/3 the level of age- and sex-matched healthy sedentary individuals.  To put this functional deficit into context, the RA patients, whose mean age was ~60 years, on average perform function test at the level as same-sex healthy individuals aged ~85 years! 

These results highlight the contribution poor body composition plays in patients’ disability, and the need for additional treatments that specifically improve body composition if meaningful improvements in RA patients’ disability and well-being are to be achieved.

This research was done in conjunction with Peter Maddison Rheumatology Centre clinicians at the Betsi Cadwaladr University Health Board, some of who hold joint appointments, as part of a long standing collaboration with the School of Sports, Health & Exercise Sciences that has produced dozens of academic papers in recent years. Also involved in the research were intercalating medical students from Cardiff University Medical School who were spending a year studying at Bangor.

Prof Lemmey said “This research provides a clear indication to providers of RA treatment that if patients are to achieve the best possible outcomes, more focus needs to be placed on specific strategies that are aimed at increasing muscle mass and strength, and reducing fat mass.”

Dr Y Ahmad said “Intensively treating RA patients earlier and with strict targets has improved outcomes such as disease activity and xray damage. But our research has demonstrated that this improvement is not seen in muscle and function wellbeing which has major implications.  This is not appreciated by Rheumatology clinicians worldwide and more emphasis is needed to understand why and how we can improve this.

Paper: Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients

Lemmey AB, Wilkinson TJ, Clayton RJ, Sheikh F, Whale J, Jones HS, Ahmad YA, Chitale S, Jones JG, Maddison PJ, O’Brien TD. Rheumatology 2016, 55(10):1736-1745.

Publication date: 10 February 2017