MedicalResearch.com Interview with:
Prof. Andrew B Lemmey
School of Sport, Health and Exercise Sciences
Bangor University
Bangor, Gwynedd, Wales, UK
Medical Research: What is the background for this study?
Prof. Lemmey: Substantial loss of lean mass (LM; mostly skeletal muscle) is common in patients with rheumatoid arthritis (RA), as we and others have shown that even amongst patients with well-controlled disease approximately 67% are significantly muscle wasted. This loss of muscle, termed “rheumatoid cachexia”, is a major contributor to the decreased strength and impaired physical function which continues to characterise RA. Unfortunately, current drug treatments for RA, including use of biologics and the ‘treat-to-target (T2T)’ strategy, do not reverse this LM loss, nor fully restore physical function (Lemmey et al., “
Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients”. Submitted to
Rheumatology (Oxford), currently under review). Whilst high-intensity exercise (specifically, progressive resistance training (PRT)) has been shown to be highly effective in restoring both lean mass and function in rheumatoid arthritis patients (Lemmey et al.,
Arthritis Care & Research 2009;61(12):1726-34), the lack of uptake and adherence to sufficiently intense training (Lemmey et al.,
Arthritis Care & Research 2012;64(1):71-5) means this form of therapy is not widely adopted. Anabolic nutritional supplementation offers a potential adjunct treatment intervention for increasing LM, and thereby improving physical function, that could be widely accepted. Indeed, our group (Marcora et al.,
Clinical Nutrition 2005;24(3):442-54) has previously demonstrated that 12 weeks of daily oral protein supplementation improved lean mass and some measures of strength and function in rheumatoid arthritis patients.
Creatine (Cr) is a popular dietary supplement generally shown to have greater benefits on both lean mass and physical function than generic protein supplementation. One study (Willer et al.,
Rheumatology 2000;39(3):293-8) has investigated the efficacy of Cr supplementation in rheumatoid arthritis patients. In this short uncontrolled trial, twelve patients underwent 3 weeks of supplementation, and although strength increased, no changes in function were found, and body composition changes were not investigated.
Using a double-blind, placebo controlled design, the current study aimed to investigate the effects of 12 weeks of oral Cr supplementation on body composition (by DXA; dual energy X-ray absorptiometry), strength (knee-extensor and handgrip) and objectively-assessed physical function (chair and walk tests) in patients with
RA. Thirty-five patients (Cr=15, Pl=20) completed the study.
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