BackgroundRheumatoid arthritis (RA) is a systemic inflammatory disease associated with polyarthritis, progressive joint damage, and physical impairment that can lead to osteoporosis and sarcopenia, increasing the risk of fractures and leading to a greater loss of autonomy in RA patients.ObjectivesTo assess frequency of osteoporosis, sarcopenia and osteosarcopenia in women with RA.Methods40 female patients with RA (mean age 63±7 years) and 40 female controls without RA (mean age 64±9 years) were enrolled in this study. Body composition and bone mineral density (BMD) in lumbar spine and proximal hip were assessed by using dual X-ray absorptiometry (DXA, Hologic Discovery A). Sarcopenia in women was defined as a skeletal muscle index (SMI) ≤5.67 kg/m21 and osteosarcopenia – if sarcopenia and low BMD were present together.2 The participants performed Short Physical Performance Battery (SPPB) and handgrip strength was measured. Body mass index (BMI) and Disease Activity Score (DAS28) were calculated.ResultsLow BMD at least in one of measured area was found out in 19 (48%) RA persons and in 18 (45%) controls. Sarcopenia occurred in 10 (25%) RA patients and in 5 (12,5%) people without RA (p>0,05). Among them osteosarcopenia was found in 6 (15%) RA women and 2 (5%) controls. Skeletal muscle index (SMI) was lower in patients with RA (6.43±0.978) than in controls (7.01±1. 064, p<0,05). In RA patients SMI had a positive correlation with BMI (r=0,58, p<0,05) and handgrip strength (r=0,34 for right, r=0,30 for left, p<0.05 for both). Sarcopenia was more common in RA patients who were normal or underweight than in those who were overweight or obese according to their BMI (p<0.01). There was no correlation between SMI and DAS28, drug use, frequency of falls during the last year, SPPB in the RA groupConclusionsIn RA patients 48% had osteoporosis and 25% – sarcopenia, among them 15% women – osteosarcopenia. The risk of sarcopenia and osteosarcopenia was higher in nonobese patients.References[1] Cruz-Jentoft AJ, et al. Sarcopenia: European consensus on definition and diagnosis. Age and Agening2010;39:412–423.[2] Hassan EB, Duque G. Osteosarcopenia: A new geriatric syndrome. Aust Fam Physician2017Nov;46(11):849–853.Disclosure of InterestNone declared
Aim. To evaluate the frequency of sarcopenia (SP) according to EWGSOP2 criteria and factors associated with low lean mass in women with rheumatoid arthritis (RA). Materials and methods. 79 women (aged 4075 years) with RA were enrolled in the study. We analyzed clinical data: age, body mass index (BMI), disease duration, methotrexate use, glucocorticoid use, anthropometric measurements, C-reactive protein level, disease activity score in 28 joints-erythrocyte sedimentation rate, bone mineral density (BMD) of the lumbar spine, femur neck, total hip and body composition by Dual energy X-ray absorptiometry. Also, muscle strength and functional tests were performed. We analyzed the correlation between disease parameters and low lean mass with the Spearman method. Results. 73 (92%) patients had low muscle strength, 20 (25%) patients had low muscle strength and low lean mass, among them 9 (11%) also had functional disability. There was no correlation between the age of patients and the presence of SP, while the duration of RA in women with SP was significantly greater (p=0.006). There were significant correlations between lean mass and body mass index, glucocorticoids used, methotrexate doses, creatinine and urea acid serum concentration, bone mineral density and falls number. Conclusion. According EWGSOP2 confirmed sarcopenia was found in 25% RA patients, among them 11% women had severe sarcopenia. Lean mass correlated with the factors related to the disease itself and some general clinical parameters, which requires further study.
Rheumatoid arthritis (RA) and the use of glucocorticoids (GCs) are proven risk factors for osteoporosis (OP) and osteoporotic fractures (OPF). There are also other reasons for increased fracture risk in RA.Objective: to determine the rate of RA in an epidemiological sample of persons aged 50 years and older and to identify those in need of antiosteoporotic therapy among the patients with RA in order to prevent OPF.Subjects and methods. The epidemiological sample included 18,018 people aged 50 years and older (13,941 women and 4,077 men; mean age, 62±10 years). The survey consisted of a unified questionnaire, measurement of daily dietary calcium intake, and calculation of a 10-year fracture risk using the FRAX® algorithm.Results and discussion. The prevalence of RA in the epidemiological population sample aged 50 years and older was 1.7% (1.9% in women and 1.2% in men; p=0.0047). The mean FRAX® values for major OPF in RA patients were significantly higher than those in non-RA individuals: 18.4±10 and 13.2±7.9%, respectively (p=0.0001) for women and 8.9±6.4 and 6.2±3.7%, respectively (p=0.0001) for men. 42% of the patients with RA were at high risk for OPF. Thus, 48% of the women with RA had FRAX® values above the therapeutic intervention threshold; and the non-RA group needed antiosteoporotic therapy significantly less (31%; p=0.00001). At the same time, the detection rate of high-risk OPF in men with and without RA did not differ significantly (8 and 5%, respectively; p>0.05). The most common risk factors (RFs) for OP and OPF in RA patients included previous fractures (33%), secondary causes of OP (30%), GC use (18%), and, additionally, smoking (33%) in male patients with RA. The female patients with RA significantly more frequently took GCs (17%) and had other secondary causes of OP and OPF (33%) than those without RA (7.7% (p=0.0001) and 23% (p=0.0004, respectively). The male patients with RA versus to the population-based control showed significant differences when they only used GCs (20 and 5%, respectively; p = 0.0001); the remaining RFs were encountered at the same frequency. Less than half of the normal daily calcium intake was observed in 20% of men and 16% of women (p=0.53).Conclusion. 42% of the RA patients aged 50 years and older were at high risk for OPF and needed antiosteoporotic therapy. Every third woman with RA had at least one other comorbidity or condition associated with the increased risk of OPF. In the male patients with RA, the FRAX® algorithm could reveal only 8% of persons at high risk for fractures, while 58% of them had two or more additional RFs that can negatively affect bone mineral density and increase the risk of fracture. To identify those who require prevention and treatment of OP and OPF, it is preferable to perform bone densitometry of the axial skeleton among male patients with RA.
Остеопороз и его осложнения (низкоэнергетические переломы) являются одной из значимых проблем в здравоохранении многих развитых стран. Социально-экономические затраты, направленные на профилактику и лечение данного заболевания, увеличиваются с каждым годом в связи с ростом продолжительности жизни населения. В России для лечения остеопороза применяются практически все препараты с противопереломным действием, которые используются в мире. Однако частота переломов в популяции снижается недостаточно, что связано не столько с неэффективностью лечения, сколько с низкой приверженностью ему. В статье представлены данные наблюдательного исследования 154 пациентов (4 мужчины и 150 женщин, средний возраст 65±7 лет), перенесших остеопоротические переломы четырех основных локализаций. Прием патогенетических препаратов начали лишь 36% опрошенных лиц. Достоверно чаще лечение получали больные с ревматическими заболеваниями, которые наблюдались у ревматолога. При анализе причин отсутствия патогенетической терапии остео пороза оказалось, что в 36% случаев не было рекомендаций травматолога, а также терапевта или врача общей практики, наблюдавших пациентов после перелома. Риск повторных переломов по FRAX ® не был оценен ни у одного пациента, а направление на денситометрическое обследование получили лишь 12% человек. Консультация в специализированном Центре остеопороза позволила увеличить долю лиц, начавших принимать противоостеопоротическую терапию, почти в два раза. Ключевые слова: остеопороз, приверженность лечению, бисфосфонаты, алендронат. O.V. DOBROVOLSKAYA, N.V. DEMIN, A.Yu. FEKLISTOV, N.V. TOROPTSOVA Federal Agency for Research Organizations of Russia, V.A.Nasonova Research Institute of Rheumatology, FGBNU, Moscow TREATMENT OF OSTEOPOROSIS IN PATIENTS WHO HAD LOW-ENERGY FRACTURES: CHALLENGES OF DIAGNOSIS AND COMMITMENT TO PATHOGENETIC TREATMENTOsteoporosis and its complications (low-energy fractures) are one of the significant health problems in many developed countries. Socio-economic costs aimed at the prevention and treatment of this disease are increasing every year due to the increased life expectancy of the population. Almost all drugs with an anti-fracture effect for the treatment of osteoporosis, which are used in the world, are used in Russia. However, the incidence of fractures in the population is reduced insufficiently, which is due to not so much ineffective treatment as to low adherence to it. The article presents data of the observational study of 154 patients (4 men and 150 women, mean age 65 ± 7 years), who had osteoporotic fractures of four main localizations. Only 36% of the questioned persons started taking pathogenetic drugs. Patients with rheumatic diseases, which were followed up by a rheumatologist, received treatment statistically more often. When analysing the reasons for the absence of pathogenetic therapy for osteoporosis, it turned out that no recommendations of a traumatologist, a therapist or general practitioner, who followed up patients after a fracture, were provided in 36% of cases. Not a sin...
Торопцова Наталья Владимировна-д.м.н., врач-ревматолог высшей квалификационной категории, зав. лабораторией остеопороза отдела метаболических заболеваний костей и суставов Федерального государственного бюджетного научного учреждения «Научно-исследовательский институт ревматологии имени В.А. Насоновой»; тел.: +7 (495) 109-29-10 Феклистов Алексей Юрьевич-младший научный сотрудник, врач-ревматолог лаборатории остеопороза отдела мета-болических заболеваний костей и суставов Федерального государственного бюджетного научного учреждения «Научно-исследовательский институт ревматологии имени В.А. Насоновой»; тел.: +7 (495) 109-29-10 РЕЗЮМЕ В течение последних 40 лет уделяется большое внимание состоянию мышечной ткани и ее функции у пожилых людей, что связано с повышенным риском падений и переломов в данной популяции лиц. В 1989 г. был предложен термин «саркопения» для обозначения снижения массы и силы скелетных мышц в процессе старения, а в 2010 г. Европейская рабочая группа по изучению саркопении представила определение и диагностические критерии данного состояния. В 2016 г. саркопении был присвоен код М62.84 для ее обозначения как заболевания мышц в МКБ-10. Статья знакомит читателей с классификацией, факторами риска и методами диагностики данного заболевания, представлены обновленные критерии его диагностики, а также дано определение понятия «остеосаркопения». Описаны возможные методы профилактики и лечения для улучшения качества жизни больных, страдающих саркопенией и остеосаркопенией.
№ 1/2015 Остеопороз и остеопатииОстеопороз (ОП) -широко распространен-ное заболевание скелета, характеризующееся сни-жением минеральной плотности кости (МПК) и нарушением ее архитектоники, вследствие чего повышается хрупкость кости и возникают пере-ломы при незначительной травме или спонтанно. Предполагается, что около 14 млн. жителей на-шей страны страдают этим заболеванием [1]. Внедрение в практику новых методов диагностики, повышение уровня знаний врачей по этой проблеме, информированность паци-ентов и достаточно широкий выбор лекарственный средств способствовалитому, что в последние годы значительно уве-личилось количество больных, получающих терапию по по-воду этого заболевания, целью которой является в первую очередь снижение риска переломов, а не только повышение МПК. Продемонстрированное в клинических исследовани-ях уменьшение частоты остеопоротических переломов раз-личной локализации на 40-60% при применении препара-тов патогенетического действия может быть достигнуто на практике только при условии высокой приверженности па-циентов лечению, т.е. тогда, когда больной строго соблюдает режим приема рекомендованного лекарства и проявляет на-стойчивость к длительной терапии, которая при ОП должна быть не менее 3-5 лет, а в ряде случаев продолжаться до 10 лет. На практике три четверти женщин, начавших терапию ОП, не были привержены ей в течение первого года, а поч-ти 50% вообще прекратили прием антиостеопоротических препаратов [2]. В тоже время было показано, что при низкой приверженности терапии ОП риск переломов увеличивал-ся на 19-36% [3]. Поэтому определение причин, негативно влияющих на продолжительность лечения и несоблюдения режима приема препаратов, и определение возможных пу-тей для уменьшения их воздействия на приверженность те-рапии остаются актуальными и сегодня.Целью нашего исследования было оценить привержен-ность пациентов терапии ОП и выявить факторы, влияющие на нее. ЛЕЧЕНИЕ БоЛЬНЫХ осТЕоПоРоЗоМ МаТериаЛы и МеТОДыВ 10 городах пяти федеральных округов РФ (Приволж-ский (ПФО), Северо-Западный (СЗФО), Сибирский (СФО), Уральский (УФО), Центральный (ЦФО)), которые участво-вали в программе «Остеоскрининг Россия» в 2010-2012гг., методом случайных чисел были отобраны 2000 пациентов (по 200 человек в каждом городе) с ОП в возрасте 50 лет и старше для последующего анкетирования. Дозвониться удалось до 1799 (90%) человек, из них 1674(84%) получили специально разработанные вопросники для анонимного ан-кетирования. 1605(80%) анкет были возвращены, из них для последующего анализа были пригодны 1565, которые и по-служили первичным материалом для данной работы. Таким образом, отвечаемость составила 78%. Среди анкетирован-ных были 86% женщин и 14% мужчин (ср. возраст 64±7лет), средняя длительность заболевания с момента постановки диагноза составила 2,7±1,8 года. Приверженность лечению оценивалась на основании вопроса о продолжительности терапии ОП с момента установления диагноза. Кроме того пациента просили ответить на вопрос сколько месяцев он принимал антиостеопоротический препарат в течение по-следних 12 м...
Aim – to identify the frequency of isolated and combined pathological phenotypes of body composition in women with rheumatic diseases and to determine the factors associated with the sarcopenic phenotype.Materials and methods. 255 women (median age 60 [54; 64] years) were included in the study: 114 patients with rheumatoid arthritis (RA), 46 – with systemic sclerosis (SSc), 56 – with osteoarthritis (OA), and 39 persons without rheumatic diseases (control). Questionnaires, anthropometric measurements, double-energy X-ray absorptiometry of the whole body, lumbar spine and proximal femur were performed. The assessment of the factors associated with the sarcopenic phenotype was carried out using a univariate regression analysis.Results. The frequency of isolated and combined pathological phenotypes in women with SSc was 34.8% and 52.2%, with RA – 51.8% and 38.6%, with OA – 71.4% and 10.7%, respectively. The sarcopenic phenotype was more often determined in patients with SSc (43.5%) and RA (29.8%) compared with women with OA (1.8%) (p<0.001). The factors associated with the sarcopenic phenotype were BMI><25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96]; p><0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p><0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004). Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI><25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 0.001). The factors associated with the sarcopenic phenotype were BMI<25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96];>˂ 25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96]; p<0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p><0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004). Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI><25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p<0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004).>˂ 0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004).Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI<25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 25 kg/m2, GC using, the presence of OP and insufficiency of calcium intake.
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