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Background: Patients with rheumatoid arthritis (RA) tend to have sarcopenia due to decreased muscle mass and function. We previously reported that 13.2% of RA patients without sarcopenia at baseline developed sarcopenia over a year using data from the prospective, observational CHIKARA study1.
Objectives: The aim was to investigate sarcopenia status and the characteristics of RA patients longitudinally.
Methods: Body composition, laboratory data, disease activity, physical function, treatment, and history of falls and fractures were investigated in 100 RA patients who participated in the CHIKARA study at baseline and at 4 years. The patients were divided into 4 groups depending on their sarcopenia status: no sarcopenia development (N group), sarcopenia development (S group), cured (C group), and persisted (P group).
Results: Of the 77 RA patients who completed the survey, 48 were in the N group; their body mass index, skeletal muscle mass index, fat percentage, estimated bone mass, and body metabolization rate at baseline were significantly elevated. On the other hand, 6 patients were in the S group; 83.3% of them experienced fractures during the 4 years, significantly more than in the other groups. Ten patients were in the P group, and their baseline MMP-3 was significantly higher than in the other groups. Thirteen patients were in the C group. There were no differences among the 4 groups in disease activity and physical function (
Characteristics of 77 RA patients by sarcopenia status at baseline and at 4-year follow-up.
| no development
| development
| cured
| persisted
| p value | |
| Baseline | |||||
| age, years | 64.5 (57.8, 72) | 70.0 (65.5, 72.3) | 61.0 (54.5, 68.3) | 72 (68, 81) | 0.062 |
| disease duration, years | 4.6 (1.1, 9.9) | 11.7 (2.8, 18.9) | 8.1 (4.2, 14.3) | 4.0 (2.2, 7.7) | 0.427 |
| biologics use, % | 37.5 | 16.7 | 30.0 | 23.1 | 0.617 |
| GC use, % | 27.1 | 16.7 | 10.0 | 23.1 | 0.678 |
| MMP-3, ng/ml | 66.8 (51.8, 103) | 52.5 (40.0, 56.7) | 82.8 (57.8, 186) | 157.5 (90.8, 250) | 0.001 |
| DAS28ESR | 3.43 ± 0.87 | 3.48 ± 1.32 | 3.36 ± 1.08 | 3.80 ± 1.27 | 0.661 |
| mHAQ | 0.31 (0, 0.50) | 0.19 (0.03, 0.44) | 0.38 (0, 0.84) | 0.50 (0.25, 0.88) | 0.383 |
| BMI, kg/m 2 | 23.4 ± 3.6 | 21.6 ± 2.4 | 19.2 ± 1.6 | 19.5 ± 2.6 | <0.001 |
| SMI, kg/m 2 | 6.8 ± 0.8 | 6.2 ± 0.6 | 5.8 ± 0.5 | 5.7 ± 0.6 | <0.001 |
| fat percentage, % | 30.4 ± 8.4 | 29.1 ± 9.1 | 23.9 ± 4.0 | 25.1 ± 8.3 | 0.046 |
| estimated bone mass, kg | 2.2 (2.0, 2.4) | 1.9 (1.8, 2.1) | 2.0 (1.7, 2.1) | 1.7 (1.7, 1.9) | 0.012 |
| BMR, kcal | 1100 (1031, 1197) | 1029 (918, 1070) | 1012 (917, 1057) | 934 (894, 1006) | 0.005 |
| Change during 4 years | |||||
| ΔDAS28ESR | -0.34 ± 0.97 | -0.52 ± 0.98 | -0.60 ± 1.46 | -0.56 ± 1.14 | 0.834 |
| ΔmHAQ | 0 (-0.25, 0.16) | 0.19 (0, 0.56) | -0.06 (-0.44, 0.94) | 0 (-0.38, 0.38) | 0.357 |
| ΔSMI, kg/m 2 | 0.0 ± 0.3 | -0.6 ± 0.3 | 0.3 ± 0.4 | -0.0 ± 0.3 | <0.001 |
| fall, % | 43.8 | 83.3 | 30.0 | 23.1 | 0.079 |
| fracture, % | 14.6 | 83.3 | 20.0 | 23.1 | 0.002 |
Data are shown as mean ± standard deviation (SD) or median (25th, 75th percentile).
GC: glucocorticoids, BMI: body mass index, SMI: skeletal muscle mass index, BMR: body metabolization rate.
Conclusion: Overall, 7.8% of RA patients developed sarcopenia during the 4-year follow-up period, and they developed fractures more frequently. Evaluation of sarcopenia is important for risk assessment of fractures.
REFERENCES:
[1]Y Yamada, M Tada, K Mandai et al. Glucocorticoid use is an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis: from the CHIKARA study. Clin Rheumatol 2020 Jun;39(6):1757-1764.
Disclosure of Interests: Yutaro Yamada: None declared, Masahiro Tada: None declared, Koji Mandai: None declared, Noriaki Hidaka: None declared, Hiroaki Nakamura Grant/research support from: Astellas and Asahi Kasei