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

Abstract

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.

Ultrasound Assessment of the Gastrocnemius Muscle as a Potential Tool for Identifying Sarcopenia in Patients with Type 2 Diabetes

“…Previous studies have shown that muscle ultrasound can be used successfully to detect changes in both muscle mass and quality in a variety of clinical conditions, such as chronic kidney disease, cirrhosis, rheumatoid arthritis, and hip fracture. [28][29][30][31] So far, there have been two studies on the use of muscle ultrasound in diabetic patients. Tan et al found that muscle thicknesses of rectus femoris (RF), vastus intermedius (VI), vastus medialis (VM) and vastus lateralis (VL) and pennate angle of VI and VM were significantly lower in type 1 diabetes than in the control group.…”

Ultrasound Measurements of Rectus Femoris and Locomotor Outcomes in Patients with Spinal Cord Injury

“…We report a significant correlation between the lower extremity muscle thickness in patients with incomplete spinal cord injury and functional scores in terms of LEMS, FIM motor, FIM walk, and WISCI II scores. Muscle thickness is believed to be a reproducible measure of muscle mass and hence has been thought to influence functional measures [ 37 , 38 , 39 ]. One possible explanation for our findings is that the participants who had a higher LEMS or ambulatory score were able to weight-bear through the affected lower extremities, activating the anti-gravity lower extremity muscles and attenuating the degree of muscle atrophy, and hence had a larger muscle thickness.…”

Ultrasound and magnetic resonance imaging as diagnostic tools for sarcopenia in immune-mediated rheumatic diseases (IMRDs)

“…Similarly, another research looked at the relationship between quadriceps muscle US morphology (muscle thickness and pennation angle) and clinical characteristics, muscular strength (grip strength test) and physical function (HAQ, TUG test) in 55 women with RA [ 82 ]. Unlike the previous trial, this research supported the use of US in detecting RA patients with impaired muscular strength and physical function.…”