Neglected extra-articular manifestations in rheumatoid arthritis patients with normal body mass index: reduced skeletal muscle overlapping overfat

Abstract

Background: Chronic inflammation in rheumatoid arthritis (RA) can induce reduced muscle mass (myopenia) and ectopic fat deposition probably showing normal body mass index (BMI). We aimed to investigate their body composition (BC) characteristics and clinical significance. Methods: BMI and BC were collected in consecutive RA patients and control subjects. Myopenia was defined by appendicular skeletal muscle mass index (ASMI) ⩽7.0 kg/m2 in men and ⩽5.7 kg/m2 in women. Overfat was defined by body fat percentage (BF%) as ⩾25% for men and ⩾35% for women. Results: There were 620 RA patients (57.6% with normal BMI) and 2537 control subjects (62.5% with normal BMI) recruited. After 1:1 age and sex matching with control subjects, RA patients with normal BMI ( n = 240) showed significantly higher prevalence of myopenia (43.3% versus 22.1%) and overfat (19.2% versus 7.1%) as well as myopenia overlapping overfat (17.1% versus 3.3%). In all RA patients with normal BMI ( n = 357), there were 18.2% patients with myopenia overlapping overfat who had the worst radiographic scores and highest rates of previous glucocorticoid treatment and hypertension. Compared with those without, normal BMI RA patients with previous glucocorticoid treatment (24.4% versus 10.3%) or hypertension (27.8% versus 13.6%) had a higher rate of myopenia overlapping overfat. Previous glucocorticoid treatment [odds ratio (OR) = 2.844, 95% confidence interval (CI) 1.441–5.614] and hypertension (OR = 2.452, 95% CI 1.283–4.685) were potential associated factors of myopenia overlapping overfat in RA patients with normal BMI. Conclusion: Myopenia overlapping overfat is an important extra-articular manifestation which should not be ignored in RA patients with normal BMI, especially with glucocorticoid treatment and hypertension.

Time to Deal with Rheumatoid Cachexia: Prevalence, Diagnostic Criteria, Treatment Effects and Evidence for Management

“…Moreover, in this normoweight subgroup of patients with RC, the worst radiographic scores and highest rates of previous GC treatment and hypertension diagnosis were also exhibited. 33 Compared to the patients not exhibiting myopenia and overfat, the normoweight ones with RA on previous GC treatment exhibited a higher rate of myopenia, overlapping with overfat. 33 In concert to this observation, Hugo and associates 41 noted that low levels of physical activity and treatment with GCs was associated with increased nutritional complications among patients with RA, including RC and metabolic syndrome.…”

“…On the other hand, in a Chinese population, Lin et al 33 evaluated the prevalence of myopenia in patients with RA against age- and sex-matched, healthy controls. Compared with the control arm, patients with RA with normal BMI exhibited a higher rate of myopenia and overfat, and a greater BF as a percent of body weight (BW).…”

“…On the other hand, Lin et al . 33 revealed that when patients with a normal BMI were considered, approximately 18.2% exhibited myopenia overlapping with overfat. Moreover, in this normoweight subgroup of patients with RC, the worst radiographic scores and highest rates of previous GC treatment and hypertension diagnosis were also exhibited.…”

Comparison of Metabolic Dysfunction-Associated Fatty Liver Disease with Non-Alcoholic Fatty Liver Disease in Identifying Cardiovascular Risk in Chinese Individuals with Rheumatoid Arthritis

“…This retrospective study was carried out based on our RA cohort [10][11][12][13] at Department of Rheumatology, Sun Yat-sen Memorial Hospital, China. Subjects > 16 years old with a con rmed diagnosis of RA (2010 criteria) [14] were recruited when they nished abdominal ultrasound examination from June 2015 to September 2021.…”

“…Available demographic and clinical data were collected at enrollment as we previously reported [10][11][12][13]. RA disease activity was assessed using the clinical disease activity index (CDAI).…”