Background: Rheumatoid arthritis (RA) is an autoimmune, inflammatory and chronic disease that may lead to loss of muscle mass, muscle strength and decreased functionality. Our objectives are to assess the quadriceps muscle morphology by ultrasound (MU) and verify its associations with clinical features, muscle strength and physical function in RA patients. Methods: In this cross-sectional study, RA women (≥18 years) were included. Morphological parameters in quadriceps muscle consisted of the muscle thickness and pennation angle of rectus femoris (RF), vastus intermedius (VI) and vastus lateralis (VL). RA activity was measured by a 28-joint disease activity score (DAS28), muscle strength by handgrip and chair stand tests, and physical function by health assessment questionnaire (HAQ), timed-up-and-go (TUG) test and short physical performance battery (SPPB). Results: Fifty-five patients were included (age: 56.73 ± 9.46 years; DAS28: 3.08 ± 1.29). Muscle thickness in RF, VI and VL were negatively associated with age (RF, p < 0.001; VI, p = 0.013; VL, p = 0.002) and disease duration (RF, p < 0.001; VI, p = 0.005; VL, p = 0.001), and were positively associated with handgrip strength (RF, p = 0.015; VI, p = 0.022; VL, p = 0.013). In addition, decreased muscle thickness in VI (p = 0.035) and a smaller pennation angle in RF (p = 0.030) were associated with higher DAS-28 scores. Conclusion: Quadriceps muscle morphology by ultrasound appears to be affected by age, disease duration, disease activity and muscle strength in patients with RA. MU can be a useful method to evaluate the impact of the disease on skeletal muscle.

BackgroundRheumatoid arthritis (RA) patients usually present extra-articular manifestations [1], which affect muscle strength, muscle mass and physical functional [2]. There are several methods to assess muscle mass and, among these methods, muscle ultrasound (MU) has been suggested as an alternative to assess muscle morphology [3].Objectives[1] To assess the MU of the quadriceps muscle and verify changes over time (1-year) in muscle thickness and pennation angle in RA patients; and [2] to verify the of changes in clinical features, muscle strength, physical functional in over time in RA patients.MethodsRA patients, age ≥18years and who met 2010 American College of Rheumatology criteria were included. Morphological parameters in quadriceps muscle consisted of the muscle thickness and pennation angle of rectus femoris (RF), vastus intermedius (VI) and vastus lateralis (VL). RA activity was measured by 28-joint disease activity score (DAS28) assessed by C-reactive protein (CRP), muscle strength by handgrip, and physical functional by health assessment questionnaire (HAQ) and timed-up-and-go (TUG) test. The paired samples Wilcoxon test was used to compare variables between the baseline and 1-year assessments. The significance level was set at p≤0.05 for all analyzes.ResultsAt baseline, 155 patients with median of age 60.00 (52.00-65.00) years old, disease duration 11.00 (6.00-20.00) years and DAS28-CRP 2.77 (2.02-3.76) were included. Until moment, twenty-two patients completed the 1-year follow-up. Among these re-evaluated patients, there was a decrease in the VL (-11%) and VI (-13%) pennation angles of quadriceps muscle, and decrease in muscle strength assessed by handgrip test (-36%) after 1-year. On the other hand, no changes were observed in muscle thickness, RF pennation angle, DAS28-CRP, HAQ, and TUG test in over time (p>0.05; table 1).ConclusionThese preliminary observations indicate that established RA patients have impaired muscle quality (pennation angles) and impaired muscle strength over time. However, it is necessary to complete the remainder of the reassessments to confirm these findings, besides verifying the associations with clinical parameters.References[1] Summers GD, et al. Rheumatology (Oxford). 2008;(4) 1124–31.[2] Dos Santos LP, et al. Diagnostics (Basel). 2021 29;11(11):2014.[3] Cruz-Jentoft AJ, et al. Age Ageing. 2019;48:16–31.Table 1.Changes after 1-year in quadriceps morphological parameters, clinical features, muscle strength, and physical functional in RA patients.At baseline, [n]At 1-year,[n]Δ,[n]pvalueMuscle thickness (cm) Rectus femoris1.01 (0.81–1.31), [154]0.89 (0.59–1.34), [22]-0.07 (-0.22–0.13), [22]0.485 Vastus intermedius1.06 (0.88–1.32), [154]0.95 (0.76–1.07), [22]-0.02 (-0.06–0.01), [22]0.115 Vastus lateralis1.47 (1.24–1.78), [155]1.36 (1.15–1.51), [22]-0.02 (-0.23–0.08), [22]0.230Pennation angle (º) Rectus femoris9.67 (7.80–11.48), [154]8.51 (7.57–9.50), [22]0.03 (-1.79–0.51), [22]0.338 Vastus intermedius9.08 (7.17–10.63), [154]7.56 (6.86–9.80), [22]-0.59 (-1.22–0.07), [22]0.013* Vastus lateralis13.09 (11.10–14.58), [155]11.89 (11.26–13.64), [22]-1.23 (-2.37– -0.03), [22]0.003*Handgrip test (kg)18.00 (10.00–24.00), [154]9.00 (3.75–14.25), [22]-2.50 (-11.25–2.25), [22]0.049*DAS28-CRP2.77 (2.02–3.76), [154]2.43 (2.03–3.39), [22]-0.31 (-1,76–0.31), [22]0.088HAQ (score)1.00 (0.50–1.63), [138]1.13 (0.60–1.47), [22]0.12 (-0.44–0.44), [13]0.944TUG (s)9.45 (7.33–10.34), [137]8.00 (7.22-8.80), [22]-0.49 (-1.15–0.92), [18]0.514Abbreviation: Δ, Delta (1year - at baseline); DAS28-CRP, 28-joint disease activity score assessed by C-reactive protein CRP; HAQ, Health assessment questionnaire; TUG, Timed-up-and-go; cm, centimeters; º, degrees; kg, kilograms; s, seconds. *p<0.05. The data are shown in median (interquartile range, IQR).AcknowledgementsWe thank the Foundation for Research Support of the Rio Grande do Sul State (Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul-FAPERGS), the Coordination for the Improvement of Higher Level Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—CAPES) institution, the Research and Events Incentive Fund (Fundo de Incentivo à Pesquisa e Eventos-FIPE) of HCPA and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq).Disclosure of InterestsNone Declared.

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Background:Sarcopenia is one of the major health problems in older patients and is defined as a progressive decrease in muscle mass and function1. Sarcopenia has only rarely been studied in systemic sclerosis (SSc) and its impact in clinical characteristics of SSc is poorly investigated.Objectives:To evaluate the associations between sarcopenia and clinical features in SSc patients.Methods:Cross-sectional study, including 82 patients who met the ACR/EULAR 2013 classification criteria for SSc. Dual-energy X-ray absorptiometry, handgrip strength, and short physical performance battery were used to assess sarcopenia according the European Working Group on Sarcopenia in Older People’s (EWGSOP) diagnostic criteria updated in 20191. Malnutrition was evaluated according to the European Society of Clinical Nutrition and Metabolism (ESPEN)2, using the Malnutrition Universal Screening Tool (MUST) to screen risk for malnutrition.Results:The mean age was 60.4 years and 91.5% were women (table 1). Sarcopenia was identified in 15 (18.3%) SSc patients. Malnutrition was diagnosed in 12 (14.6%) and was more common in patients with sarcopenia (P=0.038). Also, there were significant differences between patients with and without sarcopenia regarding Body Mass Index (P=0.001), Fat Free Mass Index (P<0.001), knee extension strength (P=0.049), and Timed Up and Go test (P=0.041). There were no differences regarding age, disease duration, Rodnan skin score (mRSS), FVC and DLCO.Table 1.Clinical characteristics of SSc patients with and without sarcopenia. Data presented as number (%) of patients, except when indicated otherwise.Patients featuresWhole(n=82)SSc patients without sarcopenia(n=67)SSc patients with sarcopenia(n=15)PvalueFemales75 (91.5)62 (92.5)13 (86.6)0.606Caucasian68 (82.9)53 (79.1)15 (100)0.258Age (years)b60.4 (10.6)60.2 (10.3)61.5 (12.3)0.678Diffuse skin involvement16 (19.5)16 (23.8)0 (0)0.082Disease duration (years)a12.8 (7.5, 19.2)12.7 (7.1,19.2)13.4 (8.9, 19.8)0.324Rodnan skin scorea4.0 (2.0, 10.0)5.0 (2.0, 10.0)2.0 (2.0,10.0)0.076Interstitial lung disease on HRCT32 (39.5)25 (37.3)7 (10.4)0.737FVC (% predicted)b88.4 (16.6)88.4 (16.9)88.3 (15.3)0.991DLCO (% predicted)b63.7 (11.9)63.6 (12.2)64.2 (11.2)0.855BMI (kg/m2)b25.6 (4.6)26.5 (4.4)21.8 (4.1)0.001FFMI (kg/m2)b15.6 (1.7)16.1 (1.6)13.8 (1.2)<0.001FMI (kg/m2)b9.5 (3.7)9.9 (3.6)7.5 (3.5)0.023Malnutrition12 (14.6)7 (10.4)5 (33.3)0.038MUST - Low risk58 (70.7)51 (76.1)7 (46.7)0.046Moderate and high risk24 (29.3)16 (23.9)8 (53.3)HAQb0.778 (0.591)0.797 (0.575)0.833 (0.576)0.825Timed Up and Go test (s)a8.41 (7.41, 10.59)8.39 (7.5, 9.4)10.23 (7, 14)0.041Knee extension strength (kgf)a21.40 (15.65, 27.52)21.70 (18.05, 28.35)14.82 (9.5, 24)0.049aMedian (25, 75thpercentiles)bMean (standard deviation)Abbreviations: BMI: body mass Index; DLCO: diffusion capacity of carbon monoxide; FFMI: fat free mass index; FMI: fat mass index; FVC: forced vital capacity; HAQ: Health Assessment Questionnaire; HRCT: high-resolution computed tomography; MUST: Malnutrition Universal Screening Tool; SSc: systemic sclerosis.Conclusion:Sarcopenia is relatively common and is associated with malnutrition in patients with SSc. In our population, sarcopenia was not associated with other features related to a more severe disease. The role of sarcopenia in the prognosis of SSc needs to be better understood in longitudinal studies.References:[1]Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.[2]Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition - An ESPEN Consensus Statement. Clin Nutr. 2015;34(3):335-40Disclosure of Interests:Vanessa Hax: None declared, Rafaela Cavalheiro do Espírito Santo: None declared, Emerson Pena: None declared, Luísa Rodrigues: None declared, Renata Ternus Pedo: None declared, Jordana Miranda de Souza Silva: None declared, Nicole Pamplona Bueno de Andrade: None declared, Andrese Aline Gasparin: None declared, Ricardo Xavier Consultant of: AbbVie, Pfizer, Novartis, Janssen, Eli Lilly, Roche, Rafael Mendonça da Silva Chakr: None declared

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BACKGROUNDRheumatoid arthritis (RA) is an autoimmune, inflammatory and chronic disease that may lead to loss of muscle mass, muscle strength and decreased functionality. Our objectives were to assess the quadriceps muscle morphology by ultrasound (MU) and verify its associations with clinical features, muscle strength and physical function in RA patients. CONCLUSIONQuadriceps muscle morphology by ultrasound appears to be affected by age, disease duration, disease activity, muscle strength and objective and subjective physical function in patients with RA. In this sense, MU may be a useful method to evaluate the impact of the disease on skeletal muscle.