Nolla Joan M, Moragues Carmen, Valencia-Muntalà Lidia, de Daniel-Bisbe Laia, Berbel-Arcobé Laura, Benavent Diego, Vidal-Montal Paola, Rozadilla Antoni, Narváez Javier, Gómez-Vaquero Carmen
Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain.
Nutrients. 2025 Jun 30;17(13):2186. doi: 10.3390/nu17132186.
: Rheumatoid arthritis (RA) is a chronic inflammatory disease frequently accompanied by comorbid conditions that contribute to disability and worsen long-term outcomes. Among these, malnutrition and osteosarcopenia remain under-recognised. This cross-sectional study aimed to assess the prevalence of malnutrition and osteosarcopenia among elderly women with RA and explore the clinical impact of these conditions. Sixty-five women over 65 years with RA were evaluated using Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and EWGSOP2-based assessments for sarcopenia; bone status was measured by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and three-dimensional DXA (3D-DXA). Malnutrition was identified in 49.2% and osteosarcopenia in 52.3% of participants. A significant bidirectional association was observed: malnourished patients had higher rates of osteosarcopenia (65.6% vs. 34.4%; < 0.05), and osteosarcopenic patients were more frequently malnourished (61.8% vs. 39.1%; < 0.05). Both conditions were associated with older age, lower body mass index (BMI), impaired muscle parameters, and reduced bone mineral density. Malnourished and osteosarcopenic patients reported worse fatigue and lower physical quality of life, despite similar inflammatory activity. Significant correlations were found between muscle mass indices and bone quality metrics assessed by 3D-DXA. These findings highlight a substantial burden of malnutrition and osteosarcopenia in elderly women with RA, even with well-controlled disease despite similar inflammatory activity (mean Disease Activity Score 28: 2.8 ± 1.0; 43.1% in remission. There is a substantial burden of malnutrition and osteosarcopenia in elderly women with RA that support the integration of systematic nutritional and musculoskeletal screening into routine care. Future studies should evaluate age- and disease-specific mechanisms and assess the benefit of multidisciplinary strategies to prevent frailty and improve long-term outcomes.
类风湿关节炎（RA）是一种慢性炎症性疾病，常伴有导致残疾并使长期预后恶化的合并症。其中，营养不良和骨质疏松性肌少症仍未得到充分认识。这项横断面研究旨在评估老年RA女性中营养不良和骨质疏松性肌少症的患病率，并探讨这些情况的临床影响。使用营养不良全球领导倡议（GLIM）标准评估65名65岁以上的RA女性的营养不良情况，并基于欧洲老年人肌少症工作组（EWGSOP2）标准评估肌少症；通过双能X线吸收法（DXA）、小梁骨评分（TBS）和三维DXA（3D-DXA）测量骨状态。49.2%的参与者被确定为营养不良，52.3%的参与者患有骨质疏松性肌少症。观察到显著的双向关联：营养不良患者的骨质疏松性肌少症发生率更高（65.6%对34.4%；P<0.05），而患有骨质疏松性肌少症的患者营养不良的情况更常见（61.8%对39.1%；P<0.05）。这两种情况都与年龄较大、体重指数（BMI）较低、肌肉参数受损和骨密度降低有关。尽管炎症活动相似，但营养不良和患有骨质疏松性肌少症的患者报告有更严重的疲劳和更低的身体生活质量。通过3D-DXA评估发现肌肉质量指数与骨质量指标之间存在显著相关性。这些发现突出了老年RA女性中营养不良和骨质疏松性肌少症的沉重负担，即使疾病得到良好控制（尽管炎症活动相似，平均疾病活动评分28：2.8±1.0；43.1%处于缓解期）。老年RA女性中存在营养不良和骨质疏松性肌少症的沉重负担，这支持将系统的营养和肌肉骨骼筛查纳入常规护理。未来的研究应评估特定年龄和疾病的机制，并评估多学科策略对预防衰弱和改善长期预后的益处。
