Objective. Rheumatoid arthritis (RA) is a chronic inflammatory disease that damages the synovial joints, and patients with it
are often anorexic and cachectic with high morbidity and mortality. Biological therapy with anti-tumor necrosis factor (TNF)-α has been
proven effective as a treatment for RA. However, the long-term effects of anti-TNF-α therapy on body weight, appetite, plasma gut hormones
and leptin have not been investigated.
Methods. Twenty RA patients received subcutaneous injections of etanercept, a chimeric protein of human IgG1 Fc and TNF receptor
p75, twice weekly for 12 consecutive months. Sequential changes in body weight, body fat, appetite rating, lipid profiles, gut hormones
and leptin were measured at baseline and at 3 and 12 months after treatment. Ten RA patients who received non-biological disease modifying
anti-rheumatic drugs were enrolled as the controls and were appraised at baseline and at 12 months after treatment (a nonrandomized
Results. Significant weight gain, hyperuricemia, decreased fasting plasma glucose-dependent insulinotropic polypeptide (GIP) levels,
and loss of post-oral glucose suppression of plasma leptin concentration were found in the patients after the 12-month course of etanercept
therapy, but not in the controls. A transient decrease in fasting plasma acyl ghrelin occurred at 3 months during etanercept treatment.
Appetite score and serum lipid profiles did not change in either group.
Conclusion. Long-term therapy with anti-TNF-α is promising in ameliorating body mass decrease in patients with active RA. Plasma
levels of ghrelin, GIP and leptin may play significant roles in maintaining energy homeostasis in the anti-inflammatory responses during