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Although it performs less well in inflammatory rheumatic disease, FiRST's opinion is close to that of the rheumatologist. It can be used by the rheumatologist in clinical practice for patients facing an apparent treatment failure and to rule out a potential FM diagnosis which could interfere with the treatment response.

BackgroundEvaluation of sarcopenia is of major relevance because of these clinical repercussions on morbidity and mortality. Although the definition should include both low muscle mass and function, a combination of the 2 criteria was not reported in inflammatory rheumatic diseases (IRDs).ObjectivesTo determine in a cohort of IRDs the prevalence of sarcopenia using established combined criteria (EWGSOP) (1).MethodsSarcopenia defined as both low muscle mass (skeletal muscle index (SMI) <7.26 kg/m2 for men; <5.45 kg/m2 for women) and impaired muscular function (handgrip strength or gait speed) (1) was assessed in active rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsoA) patients before initiating first biologic. Body composition (DXA) and related factors were compared using univariate, multivariate and correlation analysis.Results148 patients were included (Table). Sarcopenia with decrease in muscle mass and function was observed in 5 RA (7.8%), one SpA (1.7%) and one PsoA (9.1%). Sarcopenia in terms of reduced SMI only (1) was not more frequent occuring in 5 RA (7.8%), 3 SpA (5.1%) and one PsoA (9.1%). Grip strength was decreased in RA as well as muscle mass compared to SpA and PsoA but the difference was no longer significant when adjusted on age, sex, disease duration (Table). Only fat distribution differed with a trunk/peripheral fat ratio higher in PsoA. In RA, lean mass was negatively correlated with disease duration and sedentary time. In SpA and PsoA, fat mass was correlated with age, disease activity, HAQ. HAQ and CRP level negatively correlated with lean mass. No association between treatments and body composition was observed.Table 1.Characteristics and body composition of patients with RA, SpA, PsoA [mean±SD; n (%)]RA (n=74)SPA (n=63)PsoA (n=11)p/p* Age, years59.5±11.744.1±12.054.6±11.0<0.0001Women54 (73)27 (43)6 (55)0.001Disease duration, years9±15.96.4±9.45.5±6.80.4Body Mass Index25.8±6.326.6±5.828.7±5.10.3DAS284.37±1.082.78±0.913.63±1.06<0.0001BASDAI50.8±17.249.6±17.70.8HAQ0.9±0.60.7±0.51.0±0.70.09CRP, mg/l16.4±21.311.9±14.310.7±13.60.3MTX54 (73.0)6 (9.5)6 (54.6)<0.0001Steroids41 (55.4)1 (1.6)1 (9.1)<0.0001NSAIDs18 (24.3)38 (60.3)7 (63.6)<0.0001Total lean mass, kg46.7±10.853.3±11.151.1±9.8 0.004/0.6SMI, Kg/m27.2±1.48.1±1.68.0±1.7 0.009/0.5Total fat mass, kg21.9±8.121.8±10.325.5±10.70.5/0.1Fat mass index (FMI), kg/m28.2±3.27.8±4.29.6±4.30.3/0.05Overfat (Body fat percentage >27% for men and 38% for women)18 (28)18 (30.5)4 (36)0.8Trunk/peripheral fat ratio0.97±0.300.99±0.331.23±0.26 0.04/0.02 *Adjusted for age, sex, disease duration.ConclusionsSarcopenia with combined criteria (muscle mass and function) occurred in 7.8% of RA corresponding to the values of the general population aged over 70 years-old (2). Reduced muscle mass only was not highly prevalent and lower than that reported in elderly suggesting important cofactors such as functional limitations or muscle quality in sarcopenia associated with rheumatic diseases.References Cruz-Jentoft AJ et al. Age Ageing 2010;39...

Objective: Poor patient adherence to anti-TNF treatment has proven to be a major roadblock to effective management. Therapeutic patient education (TPE) is now recognized as a crucial tool in managing conditions like chronic inflammatory rheumatism and in improving treatment adherence. This study aimed to assess whether different TPE programs might improve adherence to subcutaneous anti-tumor necrosis factor (anti-TNF) treatment in patients with rheumatoid arthritis (RA), ankylosing spondyloarthritis (AS), and psoriatic arthritis (PsA). Methods: This was a retrospective, observational, monocentric study of current care practices. We included 193 patients (124 women; mean age 53.3 ± 14.8 years). All patients received subcutaneous anti-TNF treatment and one of three TPE models, delivered by a nurse, from 2009 to 2013. The cohort was grouped according to different educational models: M1: information (N=92); M2: individual TPE (N=80); and M3: individual and group TPE sessions (N=21). Adherence was assessed with the Morisky Medication Adherence Scale (MMAS-4™). Scores were rated as follows: good adherence (MMAS-4 = 4), moderate adherence (MMAS-4 = 2-3), and poor adherence (MMAS-4 = 0-1). Results: The mean disease duration was 10 years [95% CI: 5 to 18]. The cohort comprised 113 patients with RA, 73 with AS, and seven with PsA. Overall, 146 (75.7%) patients displayed good adherence, 34 (17.6%) displayed moderate adherence, and 13 (6.7%) displayed poor adherence. The M3 group displayed less adherence than the M1 and M2 groups. Old age was the only factor correlated with good adherence (p=0.005). The level of knowledge had no significant impact on adherence. Conclusion: This study demonstrated good adherence to anti-TNF treatment in patients that received TPE, particularly when it was delivered in individual sessions.

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