Gumtorntip Wanitcha, Phinyo Phichayut, Kasitanon Nuntana, Louthrenoo Worawit
From the Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Clin Rheumatol. 2025 Jun 1;31(4):142-148. doi: 10.1097/RHU.0000000000002194. Epub 2025 Jan 6.
BACKGROUND/OBJECTIVES: Sarcopenia associates with poor health-related quality of life (HRQoL). This study aimed to determine prevalence and factors associated with sarcopenia in rheumatoid arthritis (RA) patients. The HRQoL between RA patients with and without sarcopenia also was compared.
This cross-sectional study recruited RA patients, aged ≥20 years, at Chiang Mai University Hospital between May and November 2023. Their skeletal muscle mass (bioelectrical impedance analysis), grip strength (hand dynamometer), and physical performance (gait speed test) were evaluated. Sarcopenia was defined according to the Asian Working Group for Sarcopenia. Patient characteristics, disease activity, physical disability (HAQ-DI), HRQoL (SF-36), nutrition (mini nutrition assessment), and medications were recorded.
Of 299 patients (89.0% female; age 61.3 ± 11.6 years; disease duration 13.9 ± 8.6 years), 37.5% had sarcopenia (27.4% severe sarcopenia). In multivariable analysis, body mass index (odds ratio [95% confidence interval] 1.46/1 unit decrease [1.27, 1.68], p < 0.001), disease duration (1.89/10 years increase [1.27, 2.83], p = 0.002), deformity of hands/feet (3.80 [1.50, 9.61], p = 0.005), mini nutritional assessment score (1.21/1 score decrease [1.04, 1.40], p = 0.012), and high C-reactive protein (CRP) (1.94 [1.02, 3.69], p = 0.044) were independent factors associated with sarcopenia. There was no relationship between sarcopenia and disease activity (DAS-28-ESR or CRP) or medication use. RA patients with sarcopenia had higher HAQ score than those without, but potentially lower scores in physical function domain of SF-36 with adjusted mean difference of 0.2 (95% confidence interval 0.03, 0.32, p = 0.022) and -5.9 (-12.24, 0.38, p = 0.066), respectively.
About one third of the Thai RA patients in this center had sarcopenia. Low body mass index, long disease duration, joint deformity, malnutrition, and high CRP were independent factors associated with sarcopenia. Sarcopenia affects physical capabilities and the physical function domain of the HRQoL.
背景/目的：肌肉减少症与健康相关生活质量（HRQoL）较差相关。本研究旨在确定类风湿关节炎（RA）患者中肌肉减少症的患病率及其相关因素。同时比较了有和没有肌肉减少症的RA患者的HRQoL。
这项横断面研究于2023年5月至11月在清迈大学医院招募了年龄≥20岁的RA患者。评估了他们的骨骼肌质量（生物电阻抗分析）、握力（握力计）和身体表现（步态速度测试）。根据亚洲肌肉减少症工作组的定义诊断肌肉减少症。记录患者的特征、疾病活动度、身体残疾情况（健康评估问卷残疾指数，HAQ-DI）、HRQoL（36项简短健康调查，SF-36）、营养状况（微型营养评定）和用药情况。
在299例患者中（女性占89.0%；年龄61.3±11.6岁；病程13.9±8.6年），37.5%患有肌肉减少症（27.4%为严重肌肉减少症）。多变量分析显示，体重指数（比值比[95%置信区间]每降低1个单位为1.46[1.27, 1.68]，p<0.001）、病程（每增加10年为1.89[1.27, 2.83]，p = 0.002）、手/足畸形（3.80[1.50, 9.61]，p = 0.005）、微型营养评定得分（每降低1分1.21[1.04, 1.40]，p = 0.012）和高C反应蛋白（CRP）水平（1.94[1.02, 3.69]，p = 0.044）是与肌肉减少症相关的独立因素。肌肉减少症与疾病活动度（28个关节疾病活动评分-血沉或CRP）或用药情况之间无关联。有肌肉减少症的RA患者的HAQ评分高于无肌肉减少症的患者，但在SF-36身体功能领域的得分可能较低，调整后的平均差异分别为0.2（95%置信区间0.03, 0.32，p = 0.022）和-5.9（-12.24, 0.38，p = 0.066）。
该中心约三分之一的泰国RA患者患有肌肉减少症。低体重指数、病程长、关节畸形、营养不良和高CRP水平是与肌肉减少症相关的独立因素。肌肉减少症会影响身体能力和HRQoL的身体功能领域。
