Cachexia in patients with rheumatoid arthritis: a cohort study

Santo, R. C. Espirito; Silva, Jordana Ms; Lora, Priscila Schmidt; Moro, Ana Laura Didonet; Freitas, Eduarda Correa; Bartikoski, Bárbara Jonson; Andrade, Nicole Pamplona Bueno de; Palominos, Penélope Esther; Hax, Vanessa; Fighera, Tayane Muniz; Spritzer, Poli Mara; Brenol, Claiton Viegas; Chakr, Rafael Mendonça da Silva; Filippin, Lidiane Isabel; Baker, Joshua F.; Xavier, Ricardo Machado

doi:10.1007/s10067-020-05119-y

Cited by 18 publications

(26 citation statements)

References 38 publications

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“…In fact, our VL muscle thickness findings (1.61 ± 0.43 cm) were lower than those from the healthy group in this same study [34]. Santo et al (2020) [50] demonstrated that RA patients in low disease activity had a higher appendicular lean mass index (ALMI) than RA patients in moderate/high disease activity. Thus, disease activity may affect muscle mass and could explain the greater muscle thickness and pennation angle found in our study compared to Blum et al (2020) [34].…”

Section: Discussioncontrasting

confidence: 58%

Morphological Parameters in Quadriceps Muscle Were Associated with Clinical Features and Muscle Strength of Women with Rheumatoid Arthritis: A Cross-Sectional Study

et al. 2021

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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.

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Section: Discussioncontrasting

confidence: 58%

Morphological Parameters in Quadriceps Muscle Were Associated with Clinical Features and Muscle Strength of Women with Rheumatoid Arthritis: A Cross-Sectional Study

et al. 2021

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“…This result may reflect another aspect of the lower FFMI, BMI, WC, and body weight found in patients with RC compared to those without RC in this study. Earlier studies linked RC with low subjectively reported physical activity (29) and poor physical function (13,33). In this study, low-intensity physical activity was inversely associated with RC.…”

Section: Rheumatoid Cachexia and Associated Variablesmentioning

confidence: 46%

“…One study found a more obvious difference between the Engvall et al and the Elkan et al definitions (29), but others reported more subtle differences (8). The definition from Engvall et al provided a lower prevalence, probably due to the subcriterion of FFMI below the 10th percentile.…”

Section: A Uniform Definition Of Rheumatoid Cachexiamentioning

confidence: 97%

“…All the studies included in that metaanalysis used the same assessment technique (DXA) and the same clinical definition of RC (7) that were used in the present study. However, another study on patients with established RA found an RC prevalence of only 13%, based on the same definition (29). The fact that RC was prevalent in these patients, and to a similar extent in patients with established RA (7,9), implied that the changes in body composition occurred preclinically, or very early in the disease.…”

Section: Prevalencementioning

confidence: 98%

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Rheumatoid cachexia in early rheumatoid arthritis: prevalence and associated variables

Ångström

Hörnberg

Sundström

et al. 2021

Scandinavian Journal of Rheumatology

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Objective: Rheumatoid cachexia (RC) is prevalent among patients with established rheumatoid arthritis (RA). Although changes in muscle mass and fat mass have been reported in early RA, these findings have not been classified according to existing RC definitions. This study aimed to describe the prevalence of RC and associated variables in patients with early RA. Method: This cross-sectional study included 87 patients. Body composition was evaluated with dual-energy X-ray absorptiometry after a median disease duration of 15 months. RC was defined as a fat-free mass index < 10th percentile and fat mass index > 25th percentile. We also assessed the erythrocyte sedimentation rate (ESR), C-reactive protein, Disease Activity Score in 28 joints, aerobic capacity, physical activity, traditional cardiovascular disease risk factors, functional disability, and sociodemographic data. Associations between RC and the independent variables were determined with logistic regression analyses. Results: The prevalence of RC was 24%. RC was significantly associated [odds ratio (95% confidence interval)] with aerobic capacity [0.28 (0.09-0.89), p = 0.030], low-intensity physical activity [0.77 (0.60-0.99), p = 0.048], body mass index [0.78 (0.70-0.92), p = 0.002], waist circumference [0.96 (0.92-0.99), p = 0.023], body weight [0.94 (0.90-0.98), p = 0.004], and ESR at the time of diagnosis [1.02 (1.00-1.05), p = 0.033]. All of these associations remained significant after adjusting for age and gender. Conclusion: RC was highly prevalent in early RA. Patient outcome may be improved by detecting this condition early and applying treatments for improving inflammation, aerobic capacity, physical activity, and body composition.

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“… 10 However, BMI may fail to identify rheumatoid cachexia in RA patients, which is referred as loss of skeletal muscle mass and gain in fat mass causing stable weight; there is even no consensus for diagnosis criteria. 11 Chronic inflammation in RA can induce skeletal muscle atrophy and dysfunction as well as ectopic fat deposition. 2 This compensatory increased body fat may lead to normal weight or BMI in RA patients, and normal BMI was reported as high as 45–85% in Caucasian RA patients.…”

Section: Introductionmentioning

confidence: 99%

Neglected extra-articular manifestations in rheumatoid arthritis patients with normal body mass index: reduced skeletal muscle overlapping overfat

Lin

Chen

et al. 2020

Therapeutic Advances in Chronic Disease

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Background: Chronic inflammation in rheumatoid arthritis (RA) can induce reduced muscle mass (myopenia) and ectopic fat deposition probably showing normal body mass index (BMI). We aimed to investigate their body composition (BC) characteristics and clinical significance. Methods: BMI and BC were collected in consecutive RA patients and control subjects. Myopenia was defined by appendicular skeletal muscle mass index (ASMI) ⩽7.0 kg/m2 in men and ⩽5.7 kg/m2 in women. Overfat was defined by body fat percentage (BF%) as ⩾25% for men and ⩾35% for women. Results: There were 620 RA patients (57.6% with normal BMI) and 2537 control subjects (62.5% with normal BMI) recruited. After 1:1 age and sex matching with control subjects, RA patients with normal BMI ( n = 240) showed significantly higher prevalence of myopenia (43.3% versus 22.1%) and overfat (19.2% versus 7.1%) as well as myopenia overlapping overfat (17.1% versus 3.3%). In all RA patients with normal BMI ( n = 357), there were 18.2% patients with myopenia overlapping overfat who had the worst radiographic scores and highest rates of previous glucocorticoid treatment and hypertension. Compared with those without, normal BMI RA patients with previous glucocorticoid treatment (24.4% versus 10.3%) or hypertension (27.8% versus 13.6%) had a higher rate of myopenia overlapping overfat. Previous glucocorticoid treatment [odds ratio (OR) = 2.844, 95% confidence interval (CI) 1.441–5.614] and hypertension (OR = 2.452, 95% CI 1.283–4.685) were potential associated factors of myopenia overlapping overfat in RA patients with normal BMI. Conclusion: Myopenia overlapping overfat is an important extra-articular manifestation which should not be ignored in RA patients with normal BMI, especially with glucocorticoid treatment and hypertension.

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Cachexia in patients with rheumatoid arthritis: a cohort study

Cited by 18 publications

References 38 publications

Morphological Parameters in Quadriceps Muscle Were Associated with Clinical Features and Muscle Strength of Women with Rheumatoid Arthritis: A Cross-Sectional Study

Morphological Parameters in Quadriceps Muscle Were Associated with Clinical Features and Muscle Strength of Women with Rheumatoid Arthritis: A Cross-Sectional Study

Rheumatoid cachexia in early rheumatoid arthritis: prevalence and associated variables

Neglected extra-articular manifestations in rheumatoid arthritis patients with normal body mass index: reduced skeletal muscle overlapping overfat

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