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Abstract Number: 2730

Handgrip Strength Predicts the Risk of Bone Fracture and Severe Adverse Events in Patients with Systemic Necrotizing Vasculitis

Soledad Henriquez1, Bertrand Dunogué2, Raphaël Porcher3, Alexis Régent1, Pascal Cohen4, Alice Bérezné1, Sami Kolta5, Claire Le Jeunne1, Luc Mouthon6, Christian Roux5, Loïc Guillevin7, Karine Briot8 and Benjamin Terrier9, 1Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, 2Internal Medicine, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, 3Université Paris Descartes Sorbonne Paris, Paris, France, 4Department of Internal Medicine, INSERM Unité 1016, Centre de Référence pour les Maladies Auto-immunes Rares, Hôpital Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France, 5Department of Rheumatology, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, 6Department of Internal Medicine, INSERM Unité 1016, Centre de Référence pour les Maladies Auto-immunes Rares, National Referral Center for Rare Systemic Autoimmune Diseases, Paris Cochin, France, Paris, France, 7Medecine Interne, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, 8Department of Rheumatology, Cochin Hospital and Epidemiology and Biostatistics Unit,Sorbonne Paris Cité Reserach Center,Paris Descartes University,INSERM U1153, Paris, France, 9National Referral Center for Rare Systemic Autoimmune Diseases, Paris Cochin, France, Paris, France

Meeting: ACR/ARHP Annual Meeting 2018

Keywords: , ,

Session Information

Date: Tuesday, October 23, 2018

Title: Vasculitis – ANCA-Associated Poster II

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Sarcopenia, characterized by progressive loss of both muscle mass and muscle strength, has been associated with poor outcomes in various diseases. Muscle weakness is a major public health concern because it predicts future all-cause mortality and is associated with falls, disability, cardiovascular mortality and morbidity. However, its impact on systemic necrotizing vasculitides (SNVs) had never been characterized. We aimed to assess the frequency, associated factors and prognostic impact of sarcopenia in SNVs.

Methods: Patients with ANCA-associated vasculitides (AAVs) or polyarteritis nodosa (PAN) seen in our department were successively included in a longitudinal study assessing musculoskeletal parameters, cardiovascular complications and other sequelae (OSTEOVAS cohort). At inclusion, dual x-ray absorptiometry assessment skeletal muscle mass index (SMI) was obtained, and muscle strength was evaluated by handgrip strength measured with a handheld dynamometer. Handgrip strength is a simple method to assess muscle function in routine practice. Patients were prospectively followed and outcomes were recorded. Cumulative relapse, bone fracture, cardiovascular event, adverse event and mortality rates were analyzed.

Results: One hundred and twenty SNV patients were included (54 men, mean±SD age 53 ± 18 years, median SNV duration 54 months). Median follow-up was 42 months. At inclusion, 28 (23%) patients had low handgrip strength (<30 kg for men and <20 kg for women), but none exhibited low skeletal muscle mass index (<7.23 kg/m2 for men and <5.67 kg/m2 for women). At that time, low handgrip strength was significantly associated with: age (P<0.0001), type of vasculitis (P=0.011), Vasculitis Damage Index (P=0.01), prior falls (P=0.0002), osteoporosis (P=0.036), low serum albumin (P=0.003) and prealbumin (P=0.0007), high C-reactive protein (P=0.001), and low femoral neck bone-mineral density (P=0.0002), as were high Framingham risk score (P=0.008) and high fracture risk (P=0.002). During follow-up, 12 (10%) patients suffered bone fractures and 31 (26%) had vasculitis treatment-related severe adverse events. Low handgrip strength was associated (hazard ratio [95% CI]) with higher cumulative incident bone fracture rate (4.25 [.37–13.2]; P=0.012) and severe adverse events (2.80 [1.35–5.81]); P=0.006) but not relapses or cardiovascular events.

Conclusion: Handgrip strength assessed in patients with AAVs and PAN was associated with nutritional status and comorbidities, eg bone disease, and predicted the risk of bone fracture and serious adverse events during follow-up. In contrast, the utility of skeletal muscle mass index assessment in this population remains uncertain.

Disclosure: S. Henriquez, None; B. Dunogué, None; R. Porcher, None; A. Régent, None; P. Cohen, None; A. Bérezné, None; S. Kolta, None; C. Le Jeunne, None; L. Mouthon, None; C. Roux, None; L. Guillevin, None; K. Briot, None; B. Terrier, None.

To cite this abstract in AMA style:

Henriquez S, Dunogué B, Porcher R, Régent A, Cohen P, Bérezné A, Kolta S, Le Jeunne C, Mouthon L, Roux C, Guillevin L, Briot K, Terrier B. Handgrip Strength Predicts the Risk of Bone Fracture and Severe Adverse Events in Patients with Systemic Necrotizing Vasculitis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/handgrip-strength-predicts-the-risk-of-bone-fracture-and-severe-adverse-events-in-patients-with-systemic-necrotizing-vasculitis/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/handgrip-strength-predicts-the-risk-of-bone-fracture-and-severe-adverse-events-in-patients-with-systemic-necrotizing-vasculitis/