El Maghraoui Abdellah, Sadni Siham, Rezqi Asmaa, Bezza Ahmed, Achemlal Lahsen, Mounach Aziza
From the Rheumatology Department, Military Hospital Mohammed V, Rabat, Morocco.A. El Maghraoui, MD, Professor of Rheumatology; S. Sadni, MD, Fellow of Rheumatology; A. Rezqi, MD, Rheumatologist; A. Bezza, MD, Professor of Rheumatology; L. Achemlal, MD, Professor of Rheumatology; A. Mounach, MD, Rheumatologist, Rheumatology Department, Military Hospital Mohammed V.
J Rheumatol. 2015 Sep;42(9):1556-62. doi: 10.3899/jrheum.141629. Epub 2015 Aug 1.
To assess the prevalence and risk factors of rheumatoid cachexia (RC) and evaluate its relationship with osteoporosis and vertebral fractures (VF) in patients with rheumatoid arthritis (RA).
We enrolled into a cross-sectional study 178 consecutive patients with RA (82.6% women) with a mean age of 54.1 ± 11.5 years (25-82) and who fulfilled the American College of Rheumatology criteria for the classification of RA. Body composition, lateral VF assessment images, and scans of the lumbar spine and proximal femur were obtained using dual-energy x-ray absorptiometry. RC was defined by a fat-free mass index below the 10th percentile and a fat mass index above the 25th percentile compared with a reference population. VF were defined using Genant semiquantitative approach.
RC was observed in 96 patients (53.9%) and osteoporosis in 52 patients (29.2%). Comparison between women with and without RC showed that women with RC had a longer disease duration, higher disease activity variables, higher steroid cumulative dose, and higher proportion of patients with erosive arthritis. Women with RC had lower total hip bone mineral density (BMD) and T score than women without RC, while comparison in men found only body mass index to be significantly lower in men with RC. Regression logistic analysis showed an independent and significant association between RC and age and disease activity in women.
Our study showed that half of the patients with RA may have RC, a condition that was significantly associated with disease activity and low hip BMD, but not with VF.
评估类风湿性恶病质（RC）的患病率及危险因素，并评价其与类风湿关节炎（RA）患者骨质疏松和椎体骨折（VF）的关系。
我们纳入了一项横断面研究，连续纳入178例RA患者（女性占82.6%），平均年龄54.1±11.5岁（25 - 82岁），且符合美国风湿病学会RA分类标准。使用双能X线吸收法获取身体成分、侧位VF评估图像以及腰椎和股骨近端扫描图像。与参考人群相比，RC的定义为无脂肪质量指数低于第10百分位数且脂肪质量指数高于第25百分位数。VF采用Genant半定量方法定义。
96例患者（53.9%）观察到RC，52例患者（29.2%）存在骨质疏松。有RC和无RC的女性之间比较显示，有RC的女性病程更长、疾病活动变量更高、类固醇累积剂量更高以及侵蚀性关节炎患者比例更高。有RC的女性全髋骨密度（BMD）和T值低于无RC的女性，而男性比较发现仅有体重指数在有RC的男性中显著更低。回归逻辑分析显示RC与女性年龄和疾病活动之间存在独立且显著的关联。
我们的研究表明，一半的RA患者可能有RC，这种情况与疾病活动和低髋BMD显著相关，但与VF无关。
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