Частота саркопении и факторы, ассоциированные с низкой мышечной массой, у женщин с ревматоидным артритом
DOI: 10.26442/00403660.2020.05.000622
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Toroptsova N.V., Dobrovolskaya O.V., Nikitinskaya O.A., et al. Frequency of sarcopenia and factors associated with lean mass in women with rheumatoid arthritis. Therapeutic Archive. 2020; 92 (5): 15–21. DOI: 10.26442/00403660.2020.05.000622
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Материалы и методы. В исследование включены 79 женщин в возрасте 40–75 лет с достоверным РА. Проанализированы клинико-анамнестические и лабораторные данные. Обследование включало двуэнергетическую рентгеновскую абсорбциометрию поясничного отдела позвоночника, проксимального отдела бедра и всего тела. Всем пациенткам проведены тесты для оценки мышечной силы и физической формы. Ассоциации между снижением массы мышц и различными факторами оценены на основании корреляционного анализа по Спирмену.
Результаты. Снижение мышечной силы обнаружено у 73 (92%) пациенток, а мышечной массы – у 20 (25%), из них у 9 (11%) обследованных также зафиксировано нарушение функции мышц. Не выявлено корреляции между возрастом больных и наличием СП, в то же время длительность РА у женщин с СП была значимо больше (р=0,006). Выявлены статистически значимые корреляции между мышечной массой и индексом массы тела, приемом глюкокортикоидов, дозой метотрексата, индексом коморбидности, уровнем креатинина и мочевой кислоты в сыворотке крови, минеральной плотностью кости и количеством падений.
Заключение. Достоверную СП по критериям EWGSOP2 имели 25% больных РА, в том числе у 11% обследованных выявлена тяжелая СП. Нами обнаружены корреляции между мышечной массой и факторами, связанными как c самим заболеванием, так и с некоторыми общеклиническими параметрами, что требует дальнейшего изучения.
Ключевые слова: ревматоидный артрит, саркопения, мышечная масса, мышечная сила, состав тела.
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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 40–75 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.
Keywords: rheumatoid arthritis, sarcopenia, lean mass, muscle strength, body composition.
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va NV, Demin NV, et al. The risk of osteoporotic fractures in patients with rheumatoid arthritis: results of the program "Osteoscreening Russia". Nauchno-Prakticheskaya Revmatologiya (Rheumatology Science and Practice). 2018;56(3):310-5 (In Russ.) doi: 10.14412/1995-4484-2018-310-315
3. Rosenberg I. Summary comments. Am J Clin Nutr. 1989;50:1231-3. doi: 10.1093/ajcn/50.5.1231
4. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi: 10.1093/ageing/afy169
5. Díaz BB, González DA, Gannar F, et al. Myokines, physical activity, insulin resistance and autoimmune diseases. Immunology Letters. 2018;203:1-5. doi: 10.1016/j.imlet.2018.09.002
6. Alkan Melikoğlu M. Presarcopenia and its Impact on Disability in Female Patients With Rheumatoid Arthritis. Arch Rheumatol. 2017;32(1):53-9. doi: 10.5606/ArchRheumatol.2017.6078
7. Barone M, Viggiani MT, Anelli MG, et al. Sarcopenia in Patients with Rheumatic Diseases: Prevalence and Associated Risk Factors. J Clin Med. 2018;7(12):504. doi: 10.3390/jcm7120504
8. Matheï C, Pottelbergh GV, Vaes B, et al. No relation between vitamin D status and physical performance in the oldest old: Results from the Belfrail study. Age Ageing. 2013;42(2):186-90. doi: 10.1093/ageing/afs186
9. Мясоедова С.Е., Рубцова О.А., Мясоедова Е.Е. Композиционный состав тела и минеральная плотность кости у женщин при ревматоидном артрите. Клиницист. 2016;10(3):41-5 [Myasoedova SE, Rubtsova ОА, Myasoedova ЕЕ. Body composition and bone mineral density in women with rheumatoid arthritis. Clinician. 2016;10(3):41-5 (In Russ.)]. doi: 10.17650/1818-8338-2016-10-3-41-45
10. Tournadre A, Pereira B, Dutheil F, et al. Changes in body composition and metabolic profile during interleukin 6 inhibition in rheumatoid arthritis. J Cachexia, Sarcopenia Muscle. 2017;8(4):639-46. doi: 10.1002/jcsm.12189
11. Ngeuleu A, Allali F, Medrare L, et al. Sarcopenia in rheumatoid arthritis: prevalence, influence of disease activity and associated factors. Rheumatol Int. 2017;37(6):1015-20. doi: 10.1007/s00296-017-3665-x
12. Torii M, Hashimoto M, Hanai A, et al. Prevalence and factors associated with sarcopenia in patients with rheumatoid arthritis. Modern Rheumatol. 2018;29(4):589-95. doi: 10.1080/14397595.2018.1510565
13. Oliveros E, Somers VK, Sochor O, et al. The concept of normal weight obesity. Progress Cardiovasc Dis. 2014;56:426-33. doi: 10.1016/j.pcad.2013.10.003
14. Vlietstra L, Stebbings S, Meredith-Jones K, et al. Sarcopenia in osteoarthritis and rheumatoid arthritis: The association with self-reported fatigue, physical function and obesity. PLoS ONE. 2019;14(6):e0217462. doi: 10.1371/journal.pone.0217462
15. Mochizuki T, Yano K, Ikari K, Okazaki K. Sarcopenia-associated factors in Japanese patients with rheumatoid arthritis: A cross-sectional study. Geriatr Gerontol Int. 2019;19(9):907-12. doi: 10.1111/ ggi.13747
16. Lin JZ, Liang JJ, Ma JD, et al. Myopenia is associated with joint damage in rheumatoid arthritis: a cross-sectional study. J Cachexia, Sarcopenia Muscle. 2019;10:355-67. doi: 10.1002/jcsm.12381
17. Müller R, Kull M, Põlluste K, et al. Factors Associated with Low Lean Mass in Early Rheumatoid Arthritis: A Cross-Sectional Study. Medicina. 2019;55:730. doi: 10.3390/medicina55110730
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия
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N.V. Toroptsova, O.V. Dobrovolskaya, O.A. Nikitinskaya, N.V. Demin, A.Yu. Feklistov
Nasonova Research Institute of Rheumatology, Moscow, Russia