Page 79 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

AN UNFAVORABLE BODY COMPOSITION
INTRODUCTION
Inflammatory arthritis, especially rheumatoid arthritis (RA), is associated with an increased mortality(1;2) and mainly due to cardiovascular (CV) disease(3-6).
The increased CV risk is attributed to both the presence of inflammation and an increased prevalence of traditional CV risk factors(7). Atherosclerosis, which may
already accelerate in the preclinical phase of inflammatory arthritis(5), is independently associated with a high body mass index (BMI)(8;9), more specifically, with an excess of
body fat and especially fat located on the abdomen(10). Therefore, body composition
is a better predictor for CV disease than BMI(9;11;12). Body composition refers to 4 different compartments of the body, notably fat mass and fat-free mass. Fat-free
mass is also known as lean mass and includes body water, bone, organs, but primarily muscle(13). Several studies have documented that inflammatory arthritis patients have an unfavorable body composition compared to healthy controls(14-19). Their condition comprises a loss of skeletal muscle mass (more than suspected for their age), in the presence of stable or even increased fat mass (especially on the abdomen), resulting in a stable weight(20).
This unfavorable body composition is associated with CV comorbidity and a reduced life expectancy(21), but treat to target therapy did not improve patients’ body composition, while it did improve disease activity(14;22;23). Therefore, early detection is important for preventive measures. Currently it is unknown at what point in the course of the disease an unfavorable body composition develops. Several studies found an unfavorable body composition several months after diagnosis, but no research has been performed at the onset of arthritis(14;22). Therefore, the objective of this study was to compare body composition between patients at the clinical onset of arthritis with the general population. Exploratory analyses were performed to determine the relation between body composition with other traditional CV risk factors and disease factors in early arthritis patients.
MATERIALS AND METHODS
Study population and assessments
The study population comprised a cohort of consecutive patients with early arthritis from the ‘Early Arthritis Cohort’ at Reade in Amsterdam, The Netherlands. This ongoing cohort includes patients of 18 years or older, with at least two swollen joints or one swollen joint with a positive rheumatoid factor (RF) and/or anti-citrullinated protein antibody (ACPA), a symptom duration of less than 2 years and no prior treatment with disease-modifying antirheumatic drugs (DMARDs). Patients with a diagnosis of crystal arthropathy, spondyloarthritis, osteoarthritis, systemic lupus erythematosus, Sjögren’s syndrome or infectious arthritis were excluded. No exclusion criteria for cardiovascular diseases were applied. Data were used of patients included from June 2008 until January 2016. Approval was obtained from Ethics Committee of the Slotervaart Hospital and
77