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World J Rheumatol. Nov 12, 2014; 4(3): 22-34
Published online Nov 12, 2014. doi: 10.5499/wjr.v4.i3.22
Oral creatine supplementation: A potential adjunct therapy for rheumatoid arthritis patients
Thomas J Wilkinson, Thomas D O’Brien, Andrew B Lemmey
Thomas J Wilkinson, Thomas D O’Brien, Andrew B Lemmey, School of Sport, Health and Exercise Sciences, Bangor University, Wales LL57 2PZ, United Kingdom
Thomas D O’Brien, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, England L3 3AF, United Kingdom
Author contributions: Wilkinson TJ gathered literature information and drafted manuscript; O’Brien TD and Lemmey AB advised on search methodology and critically revised the manuscript.
Correspondence to: Andrew B Lemmey, Professor, School of Sport, Health and Exercise Sciences, Bangor University, George Building, Normal Site, Holyhead Road, Wales LL57 2PZ, United Kingdom.
Telephone: +44-1248-383932
Received: June 28, 2014
Revised: September 19, 2014
Accepted: October 1, 2014
Published online: November 12, 2014

Creatine is one of the most popular forms of protein supplements and is known to improve performance in healthy athletic populations via enhanced muscle mass and adenosine triphosphate energy regeneration. Clinical use of creatine may similarly benefit patients with rheumatoid arthritis (RA), an inflammatory condition characterised by generalised muscle loss termed “rheumatoid cachexia”. The adverse consequences of rheumatoid cachexia include reduced strength, physical function and, as a consequence, quality of life. Whilst regular high-intensity exercise training has been shown to increase muscle mass and restore function in RA patients, this form of therapy has very low uptake amongst RA patients. Thus, acceptable alternatives are required. The aim of this review is to consider the potential efficacy of creatine as an anabolic and ergonomic therapy for RA patients. To date, only one study has supplemented RA patients with creatine, and the findings from this investigation were inconclusive. However, trials in populations with similar losses of muscle mass and function as RA, including older adults and those with other muscle wasting conditions, indicate that creatine is an efficacious way of improving muscle mass, strength and physical function, and may offer an easy, safe and cheap means of treating rheumatoid cachexia and its consequences.

Keywords: Creatine supplementation, Nutritional supplement, Rheumatoid arthritis, Rheumatoid cachexia, Physical function

Core tip: Creatine supplementation primarily improves physical function by enhancing the re-synthesis of adenosine triphosphate via increased stores of phosphocreatine in the muscle. Through this pathway it provides greater levels of energy during physical activity and improves recovery. Creatine also augments muscle protein synthesis, thereby increasing muscle mass. These dual effects increase strength, reduce fatigue, and thereby improve function. In patients with conditions such as rheumatoid arthritis that are characterised by muscle loss and subsequent reductions in strength and physical function, creatine offers a potential therapeutic intervention for augmenting muscle mass and function that is safe, easy and inexpensive to administer.