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.
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 10). https://acrabstracts.org/abstract/handgrip-strength-predicts-the-risk-of-bone-fracture-and-severe-adverse-events-in-patients-with-systemic-necrotizing-vasculitis/. Accessed June 5, 2020.
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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/