CHRU Nancy, Rheumatology Department, F-54500, Nancy, France.
CHU Toulouse, Rheumatology Department, Toulouse, France.
Semin Arthritis Rheum. 2018 Jun;47(6):797-804. doi: 10.1016/j.semarthrit.2017.10.012. Epub 2017 Oct 18.
To analyze the associations between body composition, notably low lean mass, and clinical symptoms [pain, physical function, quality of life (QoL)] in patients with symptomatic hip and/or knee OA.
Cross-sectional study using data from the 3-year follow-up visit of the Knee and Hip OsteoArthritis Long-term assessment (KHOALA) cohort. Skeletal muscle and fat mass were measured by dual X-ray absorptiometry (DXA). Fat mass index (FMI) was defined as total fat mass/height. Appendicular lean mass was adjusted on body mass index (ALM/BMI), and low lean mass was defined according to the definition of FNIH Sarcopenia Project recommendations. Pain and function were measured by the WOMAC index and QoL by the SF-36.
In total, 358 patients underwent DXA (67% women, mean [SD] age 63.4 [8.4] years, mean BMI 29.5 [5.6]kg/m). The visual analog scale (0-100) pain score was 38.0 [24.7] and 25.4% had hip and 74.6% knee OA. Low lean mass and ALM/BMI were associated with impaired QoL and WOMAC scores on bivariate analysis (all p ≤ 0.001) but not on multivariate analysis after adjustment for FMI. For patients with normal BMI, mean [SD] WOMAC scores were higher (greater impairment) with low lean mass than normal body composition (WOMAC function 33.4 [23.3] and 24.0 [17.4], p = 0.02), and mean SF-36 physical component score was lower (greater impairment) 40.3 [10.2] and (44.3 [8.4], p = 0.04). Among patients with obesity, low lean mass had no additional effect.
For patients with OA and normal BMI, QoL and function were more impaired for those with than without low lean mass. Conserving muscle mass in people with OA could have functional and antalgic benefits especially for those with normal BMI.
分析身体成分（尤其是低瘦体重）与有症状的髋和/或膝骨关节炎患者的临床症状（疼痛、身体功能、生活质量[QoL]）之间的关联。
这是一项横断面研究，使用了 Knee and Hip OsteoArthritis Long-term assessment（KHOALA）队列的 3 年随访数据。使用双能 X 线吸收法（DXA）测量骨骼肌和脂肪量。脂肪质量指数（FMI）定义为总脂肪量/身高。调整身体质量指数（BMI）后的四肢瘦体重（ALM/BMI），并根据 FNIH 肌肉减少症项目建议的定义定义低瘦体重。使用 WOMAC 指数测量疼痛和功能，使用 SF-36 测量生活质量。
共有 358 名患者接受了 DXA 检查（67%为女性，平均[标准差]年龄 63.4[8.4]岁，平均 BMI 29.5[5.6]kg/m2）。视觉模拟评分（0-100）疼痛评分为 38.0[24.7]，髋关节炎和膝关节炎的患者分别占 25.4%和 74.6%。在单变量分析中，低瘦体重和 ALM/BMI 与 QoL 和 WOMAC 评分受损相关（均 p ≤ 0.001），但在调整 FMI 后多变量分析中无相关性。对于 BMI 正常的患者，低瘦体重的 WOMAC 评分（功能障碍程度更高）高于正常身体成分（WOMAC 功能 33.4[23.3]和 24.0[17.4]，p=0.02），SF-36 生理成分评分（功能障碍程度更高）更低（40.3[10.2]和[44.3[8.4]，p=0.04）。在肥胖患者中，低瘦体重没有额外的影响。
对于 BMI 正常的 OA 患者，与无低瘦体重的患者相比，有低瘦体重的患者的 QoL 和功能障碍更严重。在 OA 患者中保持肌肉量可能具有功能和镇痛益处，特别是对于 BMI 正常的患者。
