The effect of disease-modifying anti-rheumatic drugs on skeletal muscle mass in rheumatoid arthritis patients: a systematic review with meta-analysis

Abstract

Introduction Rheumatoid arthritis (RA) is an autoimmune disease, characterized by chronic and systemic inflammation. Besides, it is known that RA patients may present several comorbidities, such as sarcopenia, a condition where patients present both muscle mass and muscle quality impairment. RA treatment is mostly pharmacological and consists in controlling systemic inflammation and disease activity. Despite that, the effect of pharmacological treatment on sarcopenia is not well characterized. Objective To summarize the effects of disease-modifying anti-rheumatic drugs (DMARDs) on skeletal muscle tissue in rheumatoid arthritis (RA) patients. Methods A systematic review of randomized clinical trials and observational studies was conducted using MEDLINE, Embase, Cochrane Library, and Web of Science. We selected studies with rheumatoid arthritis patients treated with disease-modifying anti-rheumatic drugs (DMARDs) that analyzed muscle mass parameters such as lean mass and appendicular lean mass. Methodological quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Standardized mean difference (SMD) and 95% confidence intervals (CI) were set. A meta-analysis of observational studies was performed using the R software, and we considered significant statistics when p < 0.05. Results Nine studies were included in this systematic review. In the meta-analysis, DMARD treatment had no positive difference (p = 0.60) in lean mass. In the same way, in the appendicular lean mass parameter, our results showed that DMARDs did not have changes between baseline and post-treatment analysis (p = 0.93). Conclusion There is no evidence of a significant effect of DMARD therapy, either synthetic or biological, on muscle mass. However, this association should be investigated with more studies.

Sarcopenia in Rheumatoid arthritis. A narrative review

“…According to a recent review[ 59 ], tocilizumab can increase appendiceal and total lean mass in RA patients, which can increase muscle mass. Studies have applied the biological agent tocilizumab, a monoclonal antibody against the IL-6 receptor, whose use for a one-year period showed an increase in skeletal muscle lean mass[ 60 ].…”

Sarcopenia y su relevancia en la práctica clínica

“…En relación a los tratamientos en pacientes con AR, una revisión reciente de la literatura con metaanálisis sobre ensayos clínicos aleatorizados y estudios observacionales sobre el uso de drogas modificadoras de la enfermedad (DMARs), sintéticas y biológicas, demostró que estos medicamentos no parecen tener un efecto significativo sobre la masa muscular. A pesar de este hallazgo, los autores mencionan que se requieren más estudios para aclarar esta posible asociación 67 .…”

“…En referencia a la terapia médica, aunque algunos estudios mostraron cierta mejoría en algunos parámetros (masa muscular) utilizando dehidroepiandrosterona (DHEA), no se llegó a un consenso en su utilización. La mayoría de los estudios no evidenció mejoría consistente en la fuerza ni el rendimiento físico en pacientes con sarcopenia [65][66][67] . Hasta el momento no hay consenso para el uso de DHEA en pacientes con sarcopenia 13,68,69 .…”

Comparative efficacy and safety of JAK inhibitors and leflunomide in rheumatoid arthritis: A protocol for systematic review and meta-analysis

“…In recent years, a lot of progress has been made in the development and utilization of disease control drugs for RA, especially biological targeted therapeutic drugs, this has significantly improved the clinical symptoms and disease activity of RA patients. [ 5 – 6 ]…”