Relative muscle mass is preserved during weight loss in rheumatoid arthritis: a post-hoc RCT analysis

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ID: 320846
2026
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Abstract
Abstract Objectives Obesity and sarcopenia commonly coexist in rheumatoid arthritis (RA), compounding metabolic risk and disability. Intentional weight loss may improve outcomes but raises concern for accelerated muscle loss. We conducted a post-hoc analysis of a randomized controlled trial (RCT) of a hypocaloric, high-protein diet in adults with RA and obesity to determine whether diet-induced weight loss was associated with disproportionate reductions in muscle mass. Methods Adults with RA and obesity were randomized to a 12-week hypocaloric, high-protein diet or to control dietary advice (NCT02881307). Dual-energy X-ray absorptiometry (DXA) was performed at baseline and 12 weeks. Fat mass index (FMI), appendicular lean mass index (ALMI), and adiposity-adjusted ALMI (ALMIFMI) were derived and standardized to Z-scores using national reference data. Between-group differences in change were compared using t-tests, with FDR-adjusted P values reported for all analyses. Results Participants in the dietary intervention achieved significant reductions in total fat mass (mean change in FMI Z-score –0.35 vs 0.04; P = 0.003). Changes in ALMI Z-score (–0.37 vs –0.43; P = 0.92) and ALMIFMI Z-score (–0.15 vs –0.55; P = 0.92) did not differ significantly between groups. In the intervention group there was minimal decline in ALMFMI, suggesting parallel reductions in lean and fat tissue. Conclusion In adults with RA and obesity, diet-induced weight loss reduced adiposity without evidence of disproportionate muscle loss. These findings support the safety of structured, protein-adequate weight-loss interventions in this population.
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Authors David A. Kellner, Joshua F. Baker, Sitaram Vangala, David Elashoff, Jin Long, Veena K. Ranganath
Journal Rheumatology Advances in Practice
Year 2026
DOI
10.1093/rap/rkag080
URL
https://doi.org/10.1093/rap/rkag080
Keywords Keywords not found

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