Elsevier

Joint Bone Spine

Volume 68, Issue 5, October 2001, Pages 403-409
Joint Bone Spine

ORIGINAL ARTICLE
Nutritional status in patients with rheumatoid arthritis

https://doi.org/10.1016/S1297-319X(01)00296-2Get rights and content

Abstract

Background. Some chronic diseases have been associated to an impairment of nutritional status. Objective. To analyze nutritional status and its relation to dietary intake, disease activity and treatment in rheumatoid arthritis. Patients and methods. We have included 93 patients (43 men and 50 women) and 93 age- and sex-matched healthy controls. The assessment of nutritional status included anthropometric (body mass index, tricipital skin fold and midarm muscular circumference) and biochemical (serum albumin, prealbumin and retinol binding protein) parameters. Dietary intake was calculated from a food frequency questionnaire. As a measure of disease activity, we used the Health Assessment Questionnaire, Ritchie index, tender and swollen joint count and C-reactive protein. Statistical analysis was performed in the whole series and in every functional class. Results. In the whole series, midarm muscular circumference and serum albumin were significantly lower in patients than in controls. All anthropometric parameters and serum albumin were significantly lower in patients in functional class IV than in their respective controls. The dietary intake of energy, carbohydrates, vegetal proteins and lipids was higher in patients than in controls. Midarm muscular circumference and serum albumin had a significant inverse relation with disease activity parameters; body mass index, midarm muscular circumference and serum albumin correlated inversely with the cumulative dose of glucocorticoids. Conclusions. Patients with rheumatoid arthritis in functional class IV have an impairment of nutritional status without a deficient dietary intake. The differences found in other functional classes are explained by rheumatoid arthritis itself. Nutritional parameters are related to disease activity and glucocorticoid treatment.

Introduction

Nutritional status is the result of the balance between the dietary supply and nutritional requirements necessary to go on with physiological activities, to compensate losses and to maintain reserves. Nutritional status is a good predictor of health as shown in the studies that include general population 〚1〛 or disease states 2, 3. The assessment of nutritional status is cheap, effective and available for health professionals.

Long-standing diseases such as chronic infections are known to be associated to some degree of impairment of nutritional status, this condition being associated to a worse vital and functional prognosis 〚4〛. Rheumatoid arthritis (RA), as a chronic inflammatory disease, seems to be a good candidate to include in the list of diseases associated to undernutrition. However, clinicians do not agree about this, probably due to the difficulties of assessing some nutritional parameters in the rheumatic patients. To date, there is not strong evidence of an actual impairment of nutritional status in RA patients 5, 6, 7, 8, 9, 10, 11, 12, 13, 14.

We have undertaken a study in order to analyze the nutritional status in a group of Spanish patients with RA and to establish its relation to some factors such as diet, glucocorticoid therapy and disease activity.

Section snippets

Patients and methods

This study has been made in a tertiary university hospital. In the Rheumatology department, more than 500 patients who fulfill the American College of Rheumatology criteria for RA 〚15〛 are regularly evaluated.

Patients and controls

We classified RA patients by sex and functional class; then, within each of the eight groups, the patients were randomly selected to achieve the sample calculated. In class IV, only five men and 13 women could be included in the study.

At inclusion, none of the patients was hospitalized by a flare of the disease nor by any adverse event related to it. Selected patients were not affected by any potentially consuming diseases as neoplasms, cardiac or respiratory insufficiency and chronic liver or

Results

The demographic and clinical characteristics of the patients are shown in table I. The data about the activity of RA are presented in table II. As expected, there were no differences in the mean age of patients (62.4 ± 11.3 years) and controls (61.9 ± 11.2 years).

The results of the assessment of nutritional status are presented in table III. We did not find differences between RA patients and controls in BMI, TSF and PRE (even when adjusted by serum creatinine). MAC and ALB values were

Discussion

We have analyzed nutritional status in a large group of patients with RA, fully representative of a population of RA followed in a tertiary hospital.

Intrinsic factors associated to RA make nutritional status assessment even more necessary than in the general population. Chronic inflammation increases the metabolic index and nutritional requirements. Physical difficulties to buy and cook the food, temporo-mandibular joint involvement, impairment of mastication and swallowing due to Sjögren’s

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