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World J Rheumatol. Nov 12, 2014; 4(3): 44-53
Published online Nov 12, 2014. doi: 10.5499/wjr.v4.i3.44
Muscle wasting in rheumatoid arthritis: The role of oxidative stress
Antonios Stavropoulos-Kalinoglou, Charikleia Deli, George D Kitas, Athanasios Z Jamurtas
Antonios Stavropoulos-Kalinoglou, Charikleia Deli, Athanasios Z Jamurtas, Department of Sport and Exercise Science, University of Thessaly, 42100 Trikala, Greece
George D Kitas, Department of Rheumatology, Dudley Group NHS Foundation Trust, Russell’s Hall Hospital, Dudley, West Midlands DY1 2HQ, United Kingdom
George D Kitas, Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester M13 9PT, United Kingdom
Athanasios Z Jamurtas, Institute of Human Performance and Rehabilitation, Centre for Research and Technology Thessaly, 42100 Trikala, Greece
Author contributions: Stavropoulos-Kalinoglou A, Deli C, Kitas GD and Jamurtas AZ contributed to this paper.
Supported by The research project is implemented within the framework of the Action «Supporting Postdoctoral Researchers» of the Operational Program “Education and Lifelong Learning” (Action’s Beneficiary: General Secretariat for Research and Technology); and is co-financed by the European Social Fund (ESF) and the Greek State
Correspondence to: Antonios Stavropoulos-Kalinoglou, PhD, Department of Sport and Exercise Science, University of Thessaly, Trikala-Karyes Road, 42100 Trikala, Greece.
Telephone: +30-24-31047038 Fax: +30-24-31047038
Received: April 17, 2014
Revised: September 1, 2014
Accepted: September 23, 2014
Published online: November 12, 2014

Rheumatoid arthritis (RA), the commonest inflammatory arthritis, is a debilitating disease leading to functional and social disability. In addition to the joints, RA affects several other tissues of the body including the muscle. RA patients have significantly less muscle mass compared to the general population. Several theories have been proposed to explain this. High grade inflammation, a central component in the pathophysiology of the disease, has long been proposed as the key driver of muscle wasting. More recent findings however, indicate that inflammation on its own cannot fully explain the high prevalence of muscle wasting in RA. Thus, the contribution of other potential confounders, such as nutrition and physical activity, has also been studied. Results indicate that they play a significant role in muscle wasting in RA, but again neither of these factors seems to be able to fully explain the condition. Oxidative stress is one of the major mechanisms thought to contribute to the development and progression of RA but its potential contribution to muscle wasting in these patients has received limited attention. Oxidative stress has been shown to promote muscle wasting in healthy populations and people with several chronic conditions. Moreover, all of the aforementioned potential contributors to muscle wasting in RA (i.e., inflammation, nutrition, and physical activity) may promote pro- or anti-oxidative mechanisms. This review aims to highlight the importance of oxidative stress as a driving mechanism for muscle wasting in RA and discusses potential interventions that may promote muscle regeneration via reduction in oxidative stress.

Keywords: Rheumatoid arthritis, Oxidative stress, Muscle wasting, Inflammation, Cytokines, Exercise

Core tip: Muscle wasting is common in rheumatoid arthritis (RA) and associates with significant health burden. To date several theories have been proposed to explain why RA patients loose muscle mass but the exact underlying mechanisms are not clear. Oxidative stress is a key driver of muscle wasting in the general population; however, its potential role in muscle wasting in RA has not been studied. As it arises from this review, oxidative stress seems to contribute to muscle wasting in RA. Further research on the subject is warranted, especially focusing on the underlying mechanisms and potential interventions.