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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (6): 1009-1016. doi: 10.19723/j.issn.1671-167X.2024.06.010

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Clinical characteristics of overlapping syndromes of low muscle mass in patients with rheumatoid arthritis and their impact on physical function

Peiwen JIA, Ying YANG, Yaowei ZOU, Zhiming OUYANG, Jianzi LIN, Jianda MA, Kuimin YANG, Lie DAI*()   

  1. Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
  • Received:2024-07-31 Online:2024-12-18 Published:2024-12-18
  • Contact: Lie DAI E-mail:dailie@mail.sysu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(82171780);Basic and Applied Basic Research Foundation of Guangdong Province(2023A1515030253);Basic and Applied Basic Research Foundation of Guangdong Province(2414050002681)

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Abstract:

Objective: To investigate the clinical characteristics of overlapping syndromes of low muscle mass in Chinese patients with rheumatoid arthritis (RA) and their impact on physical function. Methods: Consecutive patients with RA were recruited from September 2019 to April 2024 at Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital. Clinical data including disease acti-vity, physical function and radiographic assessment were collected. All patients also finished measurement of body composition, grip strength, and gait speed, and overlapping syndromes of low muscle mass as well as malnutrition, sarcopenia, sarcopenic obesity, and cachexia were evaluated. The Stanford health assessment questionnaire- disability index (HAQ-DI) was used to evaluate physical function. Logistic regression was used to analyze the related factors of physical dysfunction. Results: A total of 1 016 RA patients were recruited. Their mean age was (52.4±12.5) years, and 82.5% were female. There were 557 cases (54.8%) with overlapping syndromes of low muscle mass and all of them were malnutrition. On this basis, 326 cases (32.1%) exhibited sarcopenia, 124 (12.2%) sarcopenic obesity, and 33 (3.2%) cachexia. There were 584 (57.4%) of RA patients having physical dysfunction, with varying degrees of severity 421 (41.4%) mild, 124 (12.2%) moderate, and 39 (3.8%) severe. Compared with patients without overlapping syndromes of low muscle mass (n=459) or with malnutrition only (n=231), RA patients with both malnutrition and sarcopenia (n=326) had significantly higher core disease activity indicators and higher rate of physical dysfunction (69.6% vs. 42.0% vs. 56.6%). However, compared with patients without overlapping syndromes of low muscle mass, patients with malnutrition only had lower HAQ-DI score (median 0.0 vs. 0.1) and lower rate of physical dysfunction (42.0% vs. 56.6%). Multivariate Logistic regression analysis showed that simultaneously overlapping malnutrition and sarcopenia were associated factors of physical dysfunction (OR=2.021, 95%CI: 1.067-3.828), but malnutrition only was not. Conclusion: Simultaneously overlapping malnutrition and sarcopenia can deteriorate disease activity and physical dysfunction in RA patients. The screening and evaluation of overlapping syndromes of low muscle mass, especially sarcopenia should be emphasized in patients with RA.

Key words: Rheumatoid arthritis, Overlapping syndromes of low muscle mass, Malnutrition, Sarcopenia, Physical function

CLC Number: 

  • R593.22

Table 1

Comparisons of clinical characteristics of RA patients with different overlapping syndromes of low muscle mass"

Clinical characteristics All RA (n=1 016) Without overlapping syndromes of low muscle mass (n=459) Malnutrition only (n=231) Malnutrition + Sarcopenia (n=326) P
Female, n(%) 838 (82.5) 445 (96.9) 178 (77.1)* 215 (66.0)*# < 0.001
Age/years, ${\bar x}$ ±s 52.4±12.5 52.7±11.7 48.3±13.2* 54.8±12.2# < 0.001
Disease duration/month, M (P25, P75) 65.7 (24.6, 129.1) 64.6 (25.6, 127.8) 65.0 (24.3, 122.2) 67.5 (24.3, 133.6) 0.679
Active smoking, n(%) 104 (10.2) 14 (3.1) 24 (10.4)* 66 (20.2)*# < 0.001
Positive RF, n(%) 694 (68.3) 317 (69.1) 149 (64.5) 228 (69.9) 0.320
Positive ACPA, n(%) 689 (67.8) 316 (68.8) 150 (64.9) 223 (68.4) 0.421
Core disease activity indicators, M (P25, P75)
   28TJC 2 (0, 7) 2 (0, 6) 1 (0, 5) 4 (1, 10)*# < 0.001
   28SJC 1 (0, 4) 1 (0, 3) 0 (0, 2) 2 (0, 6)*# < 0.001
   PtGA 3 (1, 5) 2 (1, 5) 2 (0, 4) 4 (2, 5)*# < 0.001
   PrGA 2 (1, 5) 1 (1, 4) 2 (0, 4)* 3 (1, 5)*# < 0.001
   Pain VAS 2 (1, 4) 2 (1, 4) 2 (0, 3)* 3 (1, 5)*# < 0.001
   ESR/(mm/h) 28 (15, 54) 28 (15, 53) 20 (10, 42)* 34 (18, 61)# < 0.001
   CRP/(mg/L) 3.6 (3.1, 13.0) 3.6 (3.1, 11.2) 3.3 (3.1, 9.3) 5.6 (3.3, 19.4)*# < 0.001
   CDAI 9 (3, 20) 8 (3, 19) 6 (2, 15) 13 (6, 26)*# < 0.001
Radiographic assessments, M (P25, P75)
   mTSS 1 (0, 11) 2 (0, 11) 1 (0, 8) 0 (0, 11) 0.401
   JSN subscore 0 (0, 4) 0 (0, 5) 0 (0, 2) 0 (0, 3) 0.463
   JE subscore 0 (0, 7) 1 (0, 7) 0 (0, 6) 0 (0, 8) 0.364

Figure 1

Venn diagram (A) and the distribution (B) of the overlapping syndromes of low muscle mass among all RA patients RA, rheumatoid arthritis; SO, sarcopenic obesity."

Figure 2

Comparisons of physical dysfunction in RA patients with different overlapping syndromes of low muscle mass A, comparisons of the prevalence of physical dysfunction (HAQ-DI>0) and varying degrees of severity (Mild, HAQ-DI≤1; Moderate, >1 and ≤2; Severe, >2 and ≤3); B, comparisons of physical dysfunction of eight subdimensions (the scores of each subdimension >0). *P < 0.05. HAQ-DI, health assessment questionnaire-disability index."

Figure 3

Associations of overlapping syndromes of low muscle mass and physical dysfunction in patients with RA RF, rheumatoid factor; CCP, citrullinated peptide antibody; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; CDAI, clinical disease activity index; mTSS, modified total Sharp score; NA, not available."

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