Sarcopenia is a progressive and generalized loss of muscle mass and function with advancing age. 1,2) This geriatric syndrome is now considered an increasing public health issue worldwide. 3) Sarcopenia is associated with adverse health outcomes such as physical impairment, mobility limitations, increased fall risk, hospitalization, and mortality. 4) In the last decade, several sarcopenia definitions and proposals for diagnostic criteria have been published. Among these, the revised consensus criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2) appear to be the most promising. The EWGSOP2 considers sarcopenia to be present when a person presents with both low muscle strength and low muscle mass. Additionally, people with low physical performance are categorized as severely sarcopenic. 3) This condition can also impact patient quality of life. Since this aspect is not straightforward for clinical evaluation, the issue is less studied so far. The existing quality of life questionnaires, such as the Short Form 36 (SF-36) and EuroQoL 5-dimension (EQ-5D), are designed for use in a broad swath of health conditions and pa

This case report describes the occurrence of symmetrical dactylitis of toes combined with chilblain-like acral lesions in a 32-year-old female patient 19 days after a mild coronavirus infection. The article addresses existing problems of managing patients after COVID-19 in daily clinical practice. Scientific evidence is pointing to a growing number of cases of articular and skin involvement associated with COVID-19. However, it remains unclear what approaches to use in the treatment of such patients.

Background:The importance of presarcopenia (low lean mass) in clinical practice is accompanied by a high risk of adverse effects such as early disability, reduced quality of life, and increased mortality.Objectives:The aim of the study was to assess the link between bone mineral density (BMD) and the state of the muscular system in adult patients with juvenile idiopathic arthritis (JIA).Methods:The study was performed in Oleksandrivska Clinical Hospital of Kyiv, Ukraine, where adult patients were transferred from pediatric rheumatologists. Inclusion criteria: patients aged 18-44 years at the time of signing the informed consent; diagnosis of JIA in childhood, verified according to ILAR criteria, duration of JIA >3 years. According to the European Working Group on Sarcopenia in the Elderly (EWGSOP) 2019, patients with a decrease in muscle mass alone were diagnosed with presarcopenia. The BMD and muscle tissue were determined in standard localizations using dual X-ray absorptiometry (DXA).Results:The study included 26 adult patients with JIA, including 10 male patients and 16 female patients. The mean age at the time of examination was 22.3 ± 8.15 years; the mean age at the onset of the disease was 9.04 ± 4.9 years. According to the ILAR classification, patients had the following variants of JIA: 3 patients with RF-negative polyarticular variant, 8 patients with persistent oligoarthritis, 4 patients with extended oligoarthritis, 6 patients with RF-positive polyarthritis variant, and 5 patients with systemic JIA. According to the EWGSOP, 2019 reduced muscle mass was calculated by skeletal muscle index (SMI); the cut-off points were considered by SMI <7 kg/m2 for male, <6 kg/m2 for female. Patients were divided into two groups depending on the presence or absence of presarcopenia. The first group (1-st group) included 16 patients with reduced muscle mass (SMI – 5,22± 0,72 kg/m2), and the second group (2-nd group) included 10 patients without reduced muscle mass (SMI – 8,05± 0,94 kg/m2). It was found that the height and weight of patients in the group of presarcopenia was lower than in the group without a low lean mass (height 1,6±0,07 m vs 1,7±0,09 m, t=-2,53; p=0,01; weight 55,06±8,3 kg, 70,0±10,8 kg, t=-3,9; p=0,0007, respectively). The age of patients (25,3±10,1 and 21,3±5,9 years for 1-st and 2-nd groups respectively) and the duration of the disease (17,1±9,5 and 10,3±6,1 for 1-st and 2-nd groups respectively) did not differ statistically between the groups. The age of the onset of JIA in both groups also did not differ (7,8±4,5 and 11,5±4,1 for the 1-st and 2-nd group respectively). The following data were obtained by DXA. The patients of 1-st group had statistically reduced BMD in the region of femoral neck - 0,927±0,15 g/cm2 vs 1,179±0,13 g/cm2, t=-3,18; p=0,006; total hip - 0,977±0,16 g/cm2 vs 1,184±0,05 g/cm2, t=-3,05, p=0,0080; total body - 1,080±0,1 g/cm2 vs 1,193±0,15 g/cm2, t=-2,19; p=0,03; and ultra-distal radius - 0,286±0,06 g/cm2 vs 0,482±0,11 g/cm2, t=-3,60; p=0,007. The BMD in the region of lumbar spine did not differ in two groups - 1,152±0,16 g/cm2 vs 1,137±0,17 g/cm2, t=0,21; p=0,8. In the group of presarcopenia there was a visible decrease in the level of the metabolite of vitamin 25(OH)D3, but not statistically significant: 15,5±7,3 nmol/l vs 19,7±8,6 nmol/l, t =1,0; p=0,3. The study has strengths such as first described presarcopenia in young adults with JIA and potential limitations such as mono-center study and a small number of patients.Conclusion:The BMD in the region of total hip, femoral neck, ultra-distal radius, and total body in patients with decreased muscle mass was significantly lower than in patients without low lean mass.References:[1]Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis [published correction appears in Age Ageing. 2019 Jul 1;48(4):601]. Age Ageing. 2019;48(1):16-31Disclosure of Interests:None declared

BackgroundFatigue is a common and frustrating symptom in many chronic inflammatory diseases, including juvenile idiopathic arthritis (JIA), impacting all parts of daily life.ObjectivesThis study aims to determine the prevalence of fatigue in young patients with JIA and to analyze its correlation with clinical characteristics of the disease, body mineral content (BMC), and bone mass density (BMD).MethodsCross-sectional study included young adults with JIA according to ILAR criteria, disease duration ≥3 years. Exclusion criteria: age<18 and >44 years, the presence of any comorbidity that could be accompanied by fatigue (diabetes, chronic kidney disease, neuropathy, obesity, chronic obstructive pulmonary disease, infections, malignancy). Demographic data and the following clinical parameters were collected: pain Visual Analog Scale (VAS) measured by patients and doctors, tender joint count (TJC), swollen joint count (SJC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Disease Activity Score 28 (DAS28), Juvenile Arthritis Disease Activity Score (JADAS27), health assessment questionnaire (HAQ), Juvenile Arthritis Damage Index-articular (JADI-A) and Juvenile Arthritis Damage Index-extra-articular (JADI-E). BMC and BMD were determined using dual photon X-ray absorptiometry (DXA). Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) short 13-item questionnaire validated in RA. Fatigue was considered mild if the FACIT-F score was ≥40, moderate if 20≤FACIT-F<40, and severe if 0≤FACIT-F<20. A p-value lower than 0.05 was considered significant.ResultsWe included 40 patients with JIA (24 women and 16 men) with a mean age of 24.4±5. The mean disease duration was 13,8±8,1 years. The mean pain VAS measured by the patient was 38,8±3,4; the mean pain VAS measured by the doctor was 33,6±4,1; the mean TJC and SJC were 4,2±4,9 and 1,9±3,2, respectively. The mean levels of ESR and CRP were 20,2±2,7 mm/h and 26,1±7,0 mg/l, respectively. The mean DAS28-ESR was 3,6±1,5, the mean JADAS27 was 13,3±8,7, and the mean HAQ score was 0.60±0.6. The mean FACIT-F score was 30.1±12.4. Fatigue was mild in 37.5% (15 patients), moderate in 35% (14 patients), and severe in 27.5% (11) of patients. A significant negative correlation was noted between the FACIT-F score and the following parameters in JIA patients: disease duration (r=-0.436, p<0.001), articular and extra-articular damage obtained by JADI-A and JADI-E indices (r=-0.393, p=0.01, r=-0.440, p=0.05, respectively), pain VAS obtained by a doctor (r=-0.358, p=0.02), but not with pain VAS obtained by the patient (r=-0.167, p=0.3), ESR (r=-0.503, p<0.001), but not with CRP (r=-0.157, p=0.3), DAS28-ESR (r=-0.414, p<0.05), JADAS27 (r=-0.391, p<0.01) but not with TJC (r=-0.080, p=0.8), and SJC (r=-0.239, p=0.2). FACIT-F score was positively associated with total BMD (r=0.364, p=0.2), femoral neck BMD (r=0.519, p=0.007), appendicular lean mass (r=0.666, p<0.001), total lean mass (r=0.622, p<0.001), and skeletal mass index (r=0.703, p<0.001), but not with HAQ (r=0.035, p=0.8).ConclusionIn our study, moderate and severe fatigue among young patients with JIA was 35% and 27.5%, respectively. The fatigue was associated with disease activity, duration of disease, articular and extra-articular damage, total and femoral neck BMD, and lean mass.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundDecreased handgrip strength is associated with many adverse outcomes, including increased all-cause mortality, and is considered a key criterion for sarcopenia [1, 2].ObjectivesThe study aims to determine handgrip strength in young adults with juvenile idiopathic arthritis (JIA) and to detect factors associated with low handgrip strength.MethodsThe single-center, cross-sectional study included 46 young adults with JIA. Anthropometric and clinical characteristics were collected, including assessment of disease activity by DAS28 and JADAS27 indices and calculation of articular and extra-articular damage by JADI-A and JADI-E indices. To determine hand grip strength, dynamometry with Jamar hand dynamometer, three times for both hands with the time of rest and fixed the highest value, was used. Thresholds for reduced muscle strength were as follows: <27 kg for males; <16 kg for females. To determine the bone mineral density (BMD) and bone mineral content (BMC) dual photon X-ray absorptiometry (DXA) was done. Calculation of skeletal mass index (SMI=appendicular lean mass divided by height2) was counted. Logistic regression analyses estimated the associations of the following independent variables: age, sex, BMI, disease activity, articular and extra articular damage, BMD, BMC, on the dependent variable handgrip strength. Statistical significance was defined as a p-value <0.05.ResultsThe study involved 26 female and 20 male patients. The average age of the patients was 24.4±5 years; the average age at the onset of the disease was 10.1±4.4 years. Thirty-two patients had reduced muscle strength (70%). Factors associated with handgrip strength are presented in Table 1.Table 1.Univariate logistic regression analyses: factors associated with reduced handgrip strength in young patients with JIAVariableCoefficient, b±mP-valueOdds ratio, OR (95% CI)AUC (95% CI)Age, years0.073 ± 0.0660.262--Sexf0.75 (0.58 - 0.87)m-2.15 ± 0.800.000.12 (0.02 - 0.56)BMI, kg/m2-0.25 ± 0.120.0430.78 (0.61 - 0.99)0.74 (0.57 - 0.86)Disease duration, years0.17 ± 0.070.0201.18 (1.03 – 1.37)0.76 (0.60 – 0.89)ESR, mm/hour0.062 ± 0.0320.055--C-reactive protein, mg/l0.007 ± 0.0100.521--Disease activity by DAS280.49 ± 0.270.072--Disease activity by JADAS270.16 ± 0.070.0221.18 (1.02 – 1.35)0.77 (0.60 – 0.89)Current glucocorticoid use1.39 ± 0.870.109--Glucocorticoid cumulative dose, mg0.00026 ± 0.000150.081--Articular damage index JADI-A0.79 ± 0.390.0452.20 (1.02 – 4.75)0.78 (0.62 – 0.90)Extra-articular damage index JADI-E0.91 ± 0.480.059--Health Assessment Questionnaire, HAQ1.28 ± 0.760.092--BMD total, g/cm2-9.29 ± 3.640.0110.001 (0.000 - 0.12)0.77 (0.60 – 0.89)Fat arms, %0.086 ± 0.0430.0101.09 (1.02 - 1.16)0.78 (0.62 -0.90)Lean mass arms, g-1.14 ±0.340.0010.32 (0.16 – 0.63)0.94 (0.81 – 0.99)Fat legs, %0.093 ± 0.0350.0071.10 (1.03 - 1.17)0.77 (0.60 – 0.89)Lean mass legs, g-0.73 ± 0.220.0010.48 (0.31 – 0.74)0.96 (0.84 – 0.99)Appendicular lean mass, g-0.49 ± 0.140.0010.61 (0.46 -0.81)0.96 (0.84 -0.99)Lean mass total, g-0.00025 ± 0.000080.0010.9997 (0.9996-0.9999)0.94 (0.82 – 0.99)Skeletal mass index, kg/m2-2.29 ± 0.730.0020.10 (0.02 – 0.42)0.97 (0.86 – 0.99)ConclusionThe results of our study demonstrate a high prevalence of low handgrip strength, up to 70 % among young patients with JIA. In these participants, lower BMI, lower total BMD and arms, legs, total lean mass and SMI, longer disease duration, higher disease activity by JADAS27 and articular index damage JADI-A, and higher percentage fat were linked to reduced handgrip strength.References[1]Leong, D.P.; Teo, K.K.; Rangarajan, S.; Lopez-Jaramillo, P.; Avezum, A., Jr.; Orlandini, A.; Seron, P.; Ahmed, S.H.; Rosengren, A.; Kelishadi, R.; et al. Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study.Lancet2015,386, 266–273.[2]Bohannon, R.W. Muscle strength: Clinical and prognostic value of handgrip dynamometry.Curr. Opin. Clin. Nutr. Metab. Care2015,18, 465–470Acknowledgements:NIL.Disclosure of InterestsNone Declared.