Myopenia is associated with joint damage in rheumatoid arthritis: a cross-sectional study
Myopenia is associated with joint damage in rheumatoid arthritis: a cross-sectional study
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肌减少与类风湿性关节炎的关节损伤有关：一项横断面研究
DOI：
10.1002/jcsm.12381
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发表时间：
2019-04-01
影响因子：
8.9
通讯作者：
Dai, Lie
中科院分区：
文献类型：
--
作者：
Lin, Jian-Zi;Liang, Jin-Jian;Dai, Lie
背景：体重指数（BMI）和类风湿关节炎（RA）疾病特征之间的联系仍存在争议。身体成分（BC）已被更频繁地推荐使用，而不是BMI更准确的评估。我们的研究旨在调查RA患者的BC特征及其与疾病特征的关系。方法采用生物电阻抗分析法对RA患者和健康对照者的身体成分进行测定。肥胖的定义是体脂百分比（BF%），男性>= 25%，女性>= 35%。肌减少症的定义为非典型性骨骼肌质量指数（ASMI）1。放射学关节损伤（RJD）定义为Sharp/货车der Heijde改良Sharp评分（mTSS）>10。结果共纳入457例RA患者（平均年龄49.5 ± 13.1岁，女性占82.7%）和1860例对照组（平均年龄34.3 ± 9.9岁，女性占51.2%）。按年龄和性别分层比较RA患者和对照组的BMI和BC，结果显示RA患者的主要特征是BMI较低，体重不足占17.7%，ASMI较低，肌肉减少占45.1%。与无肌减少的RA患者相比，肌减少的RA患者DAS 28-CRP显著升高（中位数3.5 vs. 3.0），HAQ-DI较高（中位数0.38 vs. 0.13），功能受限率较高mTSS（中位数22.3 vs. 9.0）和RJD（中位数71.8% vs. 45.8%）更高（均P < 0.001）。多因素Logistic回归分析显示，肌减少与功能受限（OR = 2.546，95% CI：1.043-6.217）和RJD（OR = 2.660，95% CI：1.443-4.904）呈正相关。所有RA患者根据肥胖和肌减少分为4个BC亚组。那些同时患有过胖和肌肉减少的人具有最差的疾病特征。调整混杂因素后，在活动性疾病（AP = 0.528，95% CI：0.086-0.971）、功能受限（AP = 0.647，95% CI：0.356-0.937）和RJD（AP = 0.514，95% CI：0.139-0.890）中，观察到肥胖和肌减少之间存在显著的累加相互作用。结论类风湿关节炎患者普遍存在肌细胞减少，并与关节功能受限和关节损害有关。骨骼肌质量改善在RA治疗中的潜在机制和作用值得进一步研究。
Background The link between body mass index (BMI) and disease characteristics in rheumatoid arthritis (RA) remains controversial. Body composition (BC) has been more frequently recommended to be used instead of BMI for more accurate assessment. Our study aimed to investigate the characteristics of BC in RA patients and their associations with disease characteristics. Methods Body composition was assessed in consecutive Chinese RA patients and control subjects by bioelectric impedance analysis. Overfat was defined by body fat percentage (BF%) as >= 25% for men and >= 35% for women. Myopenia was defined by appendicular skeletal muscle mass index (ASMI) 1. Radiographic joint damage (RJD) was defined as the Sharp/van der Heijde modified sharp score (mTSS) >10. Results There were 457 RA patients (mean age 49.5 +/- 13.1 years old with 82.7% women) and 1860 control subjects (mean age 34.3 +/- 9.9 years old with 51.2% women) recruited. Comparisons of BMI and BC between RA patients and control subjects in age and gender stratification showed that lower BMI with 17.7% underweight and lower ASMI with 45.1% myopenia are the main characteristics in RA patients. Compared with those without myopenia, RA patients with myopenia had significantly higher DAS28-CRP (median 3.5 vs. 3.0), higher HAQ-DI (median 0.38 vs. 0.13) with higher rate of functional limitation (24.8% vs. 7.6%), and higher mTSS (median 22.3 vs. 9.0) with more RJD (71.8% vs. 45.8%) (all P < 0.001). Multivariate logistic regression analysis showed myopenia were positively associated with functional limitation (OR = 2.546, 95% CI: 1.043-6.217) and RJD (OR = 2.660, 95% CI: 1.443-4.904). All RA patients were divided into four BC subgroups according to overfat and myopenia. Those with both overfat and myopenia had the worst disease characteristics. After adjustment for confounding factors, significant additive interactions were observed between overfat and myopenia in active disease (AP = 0.528, 95% CI: 0.086-0.971), functional limitation (AP = 0.647, 95% CI: 0.356-0.937), and RJD (AP = 0.514, 95% CI: 0.139-0.890). Conclusions Myopenia is very common in RA patients that is associated with functional limitation and joint damage in RA. Further research on the underlying mechanism and the effect of skeletal muscle mass improvement in RA management are worth exploring in the future.