Factors Associated with Low Lean Mass in Early Rheumatoid Arthritis: A Cross-Sectional Study

Abstract

Background and Objectives: The aim of the study was to evaluate body composition (BC) of rheumatoid arthritis (RA) patients at disease onset compared to population controls focusing on the associations between low lean mass and disease specific parameters, nutritional factors and physical activity. Materials and Methods: 91 patients with early rheumatoid arthritis (ERA) (72% female) and 328 control subjects (54% female) were studied. BC-lean and fat mass parameters were measured with a Lunar Prodigy Dual Energy X-Ray Absorptiometry (DXA) machine. The prevalence, age and gender adjusted odds ratios of having low lean mass and overfat, associations between nutrition, physical activity, and ERA disease specific parameters and the presence of low lean mass were evaluated. Results: We found that the BC of patients with recent onset RA differs from control subjects—ERA patients had a higher mean body fat percentage (BFP) and lower appendicular lean mass (ALM). 41.8% of the ERA patients and 19.8% of the controls were classified as having low lean mass adjusted OR 3.3 (95% C.I. 1.9–5.5, p < 0.001). 68.1% of the ERA subjects and 47.3% of the controls were overfat (adjusted OR 1.9 (95% C.I. 1.1–3.3, p = 0.02)) and the adjusted odds of having both low lean mass and overfat were 4.4 times higher (26.4% vs. 7.0% 95% C.I. 2.3–8.4, p < 0.001) among the ERA group. Higher ESR (OR 1.03, C.I. 1.002–1.051, p = 0.03), CRP (OR 1.03, C.I. 1.002–1.061, p = 0.04), lower protein intake (OR 0.98 C.I. 0.96–0.99, p = 0.04), corticosteroid usage (OR 3.71 C.I. 1.4–9.9, p < 0.01) and lower quality of life (higher HAQ score OR 2.41 C.I. 1.24–4.65, p < 0.01) were associated with having low lean mass in the ERA group (adjusted to age and gender). Conclusions: Patients with early RA have lower appendicular lean mass and higher body fat percentage compared to healthy controls. Loss of lean mass in early RA is associated with elevated inflammatory markers inducing catabolism, lower protein intake and also with GCS treatment.

Prognostic impacts of glucocorticoid treatment in patients with polymyalgia rheumatica and giant cell arteritis

“…Glucocorticoids are partly responsible for the loss of bone mass and changes in body composition seen in several rheumatic diseases like SLE or RA 17,[19][20][21][22] . They have negative effects on BMC and are the principal cause for secondary osteoporosis 50 .…”

Sarcopenia in Autoimmune and Rheumatic Diseases: A Comprehensive Review

“…The factors associated with sarcopenia in RA have been demonstrated in many studies ( Table 2 ). Old age [ 36 , 37 ], BMI [ 34 , 35 , 36 ], high body fat mass [ 35 , 38 ], longer disease duration [ 37 , 74 ], bone erosion [ 34 ], low hip bone mineral density [ 36 ], malnutrition [ 37 ], low protein intake [ 72 ], and joint damage [ 30 , 33 , 37 ] were all associated with sarcopenia. Acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) [ 30 , 36 , 68 , 72 ], rheumatoid factor (RF) [ 26 , 30 ], and matrix metalloprotease 3 (MMP3) [ 35 ] were also associated.…”

“…In contrast, treatment of RA using glucocorticoids (GCs) seemed to exacerbate sarcopenia. It has been reported that GCs use was positively associated with low lean mass or sarcopenia in RA patients [ 38 , 72 ]. In a chronic polyarthritis mouse model, GCs treatment prevented inflammatory bone loss but significantly increased muscle wasting [ 75 ].…”

Circulating Pro- and Anti-Inflammatory Metabolites and Its Potential Role in Rheumatoid Arthritis Pathogenesis

“…RA patients present several comorbidities including obesity, metabolic syndrome, and sarcopenia, probably triggered by a disbalance of proinflammatory cytokines including TNF and IL-6 among other causes [73][74][75][76][77], that will modify the circulating metabolites [78]. Several studies have investigated circulating metabolic changes related to the metabolic syndrome and obesity [79,80].…”