Cachexia in Systemic Lupus Erythematosus: Risk Factors and Relation to Disease Activity and Damage

Abstract

Objective Cachexia is a disorder characterized by involuntary weight loss in addition to loss of homeostatic control of both energy and protein balance. Despite an abundance of data from other inflammatory diseases, cachexia in systemic lupus erythematosus (SLE) remains a largely undescribed syndrome. The present study was undertaken to define the prevalence of cachexia in SLE and to identify the main factors that place patients at risk of developing cachexia. Methods A total of 2,452 patients in a prospective SLE cohort had their weight assessed at each visit. Patients were categorized into 5 predetermined groups based on weight. Cachexia was defined based on modified Fearon criteria (5% stable weight loss in 6 months without starvation relative to the average weight in all prior visits and/or a weight loss of >2% without starvation relative to the average weight in all prior cohort visits and a body mass index [BMI] of <20 kg/m2). Risk of cachexia within 5 years of cohort entry was based on Kaplan‐Meier estimates. The association of prior disease manifestations with risk of cachexia adjusted by current steroid use was determined using Cox regression. An analysis of variance test was used to determine whether Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) scores varied based on cachexia status. Results Within 5 years of cohort entry, 56% of patients developed cachexia, 18% of which never recovered their weight during follow‐up. The risk factors for cachexia development were a BMI of <20 kg/m2, current steroid use, vasculitis, lupus nephritis, serositis, hematologic lupus manifestations, positive anti–double‐stranded DNA, anti‐Sm, and anti‐RNP. Patients with intermittent cachexia had significantly higher SDI scores compared to those with continuous cachexia or without cachexia. Conclusion Cachexia is an underrecognized syndrome in patients with SLE. SLE patients with intermittent cachexia have the highest risk of future organ damage.

Superior Mesenteric Artery Syndrome in Systemic Lupus Erythematosus

“…A decreased appetite and subsequent weight loss fall under the umbrella of depression. Recent studies have also shown that cachexia, or involuntary weight loss, is an under-recognized symptom in patients with SLE [ 12 ]. The mechanisms underlying this phenomenon are currently under research, with multiple theories involving pro-inflammatory mediators [ 12 ].…”

“…Recent studies have also shown that cachexia, or involuntary weight loss, is an under-recognized symptom in patients with SLE [ 12 ]. The mechanisms underlying this phenomenon are currently under research, with multiple theories involving pro-inflammatory mediators [ 12 ]. Other studies have shown that lupus may interfere with the production or usage of leptin, causing decreased appetite and increased energy use, leading to the compression of the SMA [ 13 ].…”

Mendelian randomization study on the causal effects of systemic lupus erythematosus on major depressive disorder

“…Interestingly, the authors found that the incidence of depression decreased as the time to SLE diagnosis increased, which may be due to better control of disease activity, less prednisone used and coping ability increased over time [ 41 ]. Stojan et al reported that 59% of SLE patients experienced a significant decrease in BMI within 5 years [ 42 ]. Our study demonstrated that smoking and BMI are clear predictors of MDD and the relationship between lower BMI and lower risk of MDD was verified in our multivariable MR.…”

Addition of constitutional symptoms to the SLEDAI-2K improves overall disease activity assessment: A pilot study

“…This threshold was based on the consensus definition of weight loss as part of the cachexia syndrome, 42 previously applied to SLE. 6 This degree of weight loss over a month in elderly patients without SLE also associated with a 10-fold increased risk of death. 43 Lymphadenopathy was assessed by physical exam and categorized as 0.5 to ≤1.0 cm or ≥1.0 cm, based on the largest palpated lymph node.…”

“…[3][4][5] Involuntary weight loss, generally up to 10% of body weight, is reported in up to 51% of patients, often early in disease, and associates with other SLE manifestations. [6][7][8] Physiologically, this may be explained by the cachexia syndrome, characterized by loss of metabolic homeostasis linked to overlapping pro-inflammatory mediators in SLE and other chronic diseases. 9 Fatigue may be the most prevalent symptom in SLE patients with up to 90% affected, 10 and profoundly affects quality of life.…”