Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia.
Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia.
Calcif Tissue Int. 2021 Nov;109(5):475-489. doi: 10.1007/s00223-021-00873-w. Epub 2021 Jun 16.
To examine the prevalence of sarcopenia and its association with antirheumatic drugs in adults with rheumatoid arthritis (RA). This review was registered on PROSPERO and followed PRISMA guidelines. Electronic databases were searched for studies reporting on the prevalence of sarcopenia in adults with RA using any muscle index (muscle mass, strength and/or physical performance) and cutpoints as recommended by established criteria (EWGSOP1/2, AWGS, FNIH, SDOC). The secondary objective was to investigate the relationship between RA, antirheumatic drugs, and sarcopenia. Among 2240 middle-aged and older adults with RA (mean age: 47.7 ± 5.5 to 75.0 ± 6.2 years, 83.8% women), the pooled prevalence of low muscle mass/sarcopenia was 30.2% [95% confidence interval (CI) 24.2-36.2%; 16 studies; I: 89.2%]. Sub-group analysis showed a non-significant higher prevalence of low muscle mass alone (32.6%, 95% CI 25.0-40.3%; I: 87.9%) versus consensus definitions of sarcopenia (25.4%, 95% CI 15.4-35.3%; I: 91.2%, p = 0.255). In adults with RA, corticosteroid use was positively associated with sarcopenia [odds ratio (OR) 1.46, 95% CI 0.94-2.29, 7 studies; I: 47.5%] while conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was inversely associated (OR 0.70, 95% CI 0.52-0.94; 6 studies: I: 0.00%) with this muscle disease. No association was found for biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) (OR 0.83, 95% CI 0.54-1.30; 6 studies: I: 47.6%). Sarcopenia is a common comorbidity of RA, and as such, clinicians should screen for this muscle disease in adults with RA. Further longitudinal studies are needed to understand the role of antirheumatic drugs (particularly type, dosing, and duration) in the development of sarcopenia.
探讨成年人类风湿关节炎（RA）中肌少症的流行情况及其与抗风湿药物的关系。本综述已在 PROSPERO 上注册，并遵循 PRISMA 指南。检索电子数据库，以查找使用任何肌肉指数（肌肉质量、力量和/或身体表现）和既定标准推荐的切点（EWGSOP1/2、AWGS、FNIH、SDOC）报告成年人 RA 中肌少症流行情况的研究。次要目标是研究 RA、抗风湿药物和肌少症之间的关系。在 2240 名中年及以上 RA 患者（平均年龄：47.7±5.5 至 75.0±6.2 岁，83.8%为女性）中，低肌肉量/肌少症的总患病率为 30.2%（95%CI 24.2-36.2%；16 项研究；I：89.2%）。亚组分析显示，单独低肌肉量的患病率较高（32.6%，95%CI 25.0-40.3%；I：87.9%）与肌少症的共识定义（25.4%，95%CI 15.4-35.3%；I：91.2%，p=0.255）无统计学差异。在 RA 成年人中，皮质类固醇的使用与肌少症呈正相关（比值比[OR]1.46，95%CI 0.94-2.29，7 项研究；I：47.5%），而传统合成改善病情抗风湿药物（csDMARDs）呈负相关（OR 0.70，95%CI 0.52-0.94；6 项研究：I：0.00%）与这种肌肉疾病。生物/靶向合成改善病情抗风湿药物（b/tsDMARDs）与肌少症无相关性（OR 0.83，95%CI 0.54-1.30；6 项研究：I：47.6%）。肌少症是 RA 的常见合并症，因此，临床医生应在 RA 成年患者中筛查这种肌肉疾病。需要进一步的纵向研究来了解抗风湿药物（尤其是类型、剂量和持续时间）在肌少症发展中的作用。
