Unfavorable Body Composition Already at the Onset of Clinical Arthritis

Samina A. Turk^1,2, Dirkjan van Schaardenburg^3,4, Maarten Boers^4,5, Sylvia de Boer¹, Cindy Fokker¹, Willem F. Lems^4,5 and Michael Nurmohamed^1,5, ¹Rheumatology, Amsterdam Rheumatology and immunology Center | Reade, Amsterdam, Netherlands, ²Rheumatology, Amsterdam Rheumatology and immunology Center | Academic Medical Center, Amsterdam, Netherlands, ³Amsterdam Rheumatology and immunology Center | Academic Medical Center, Amsterdam, Netherlands, ⁴Amsterdam Rheumatology and immunology Center | Reade, Amsterdam, Netherlands, ⁵Rheumatology, Amsterdam Rheumatology and immunology Center | VU University Medical Center, Amsterdam, Netherlands

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: body mass, Dual energy x-ray absorptiometry (DEXA), Early Rheumatoid Arthritis, obesity and sarcopenia

Session Information

Date: Monday, November 6, 2017

Title: Rheumatoid Arthritis – Clinical Aspects III: Obesity and Other Comorbidities

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose:

An unfavorable body composition is often present in chronic arthritis patients. This unfavorable composition is a loss of muscle mass (sarcopenia), with a stable or increased (abdominal) fat mass (sarcopenic obesity). Since it is unknown when this unfavorable composition develops, we compared body composition in disease-modifying antirheumatic drugs (DMARD)-naive early arthritis patients with non-arthritis controls and explored the association, in early arthritis patients, with disease activity and traditional cardiovascular risk factors.

Methods:

317 consecutive early arthritis patients (84% rheumatoid arthritis according to 2010 ACR/EULAR criteria) and 1268 age-/gender-/ethnicity-matched non-arthritis controls underwent a Dual-energy X-ray absorptiometry scan to assess fat percentage, fat mass index, fat mass distribution and lean (muscle) mass index. Additionally, disease activity, acute phase proteins, lipid profile and blood pressure were evaluated.

Results:

Sarcopenia and sarcopenic obesity was 4-5 times more common in early arthritis patients, with a significantly lower mean lean mass index (females 6% and males 7% lower, p<0.01). Patients had more fat distributed to the trunk (females p<0.01, males p=0.07) and females had a 4% higher mean fat mass index (p<0.01). An unfavorable body composition was associated with a higher blood pressure and an atherogenic lipid profile. There was no relationship with disease activity, physical function or acute phase proteins.

Conclusion:

Sarcopenia and sarcopenic obesity is 4-5 times more common in early arthritis patients, and is in early arthritis patients associated with a higher blood pressure and an atherogenic lipid profile. Therefore, cardiovascular risk is already increased at the clinical onset of arthritis making cardiovascular risk management necessary in early arthritis patients.

Figure. Prevalence of sarcopenia and sarcopenic obesity in early arthritis patients compared with non-arthritis controls.

Table. Body composition of early arthritis patients and non- arthritis controls stratified for gender.

Mean values for control females

(n=880)

Differences for female arthritis patients (n=220), B or OR and (CI) p-value

Mean values for control males (n=388)

Differences for male arthritis patients (n=97), B or OR and (CI) p-value

BMI

27.1 (4.7)

1.0

(0.26-1.70) 0.008*

27.4 (3.7)

-0.3

(-1.11-0.61) 0.573

LMI

7.0 (0.8)

-0.3

(-0.44- -0.19) <0.001*

8.6 (1.0)

-0.6

(-0.83- -0.39) 0.001*

FMI

26.6 (4.6)

1.1

(0.38-1.78) 0.003*

27.4 (3.6)

-0.6

(-1.45-0.23) 0.154

Android to gynoid fat mass ratio

0.5 (0.2)

<0.1

(-0.04-0.00) 0.102

0.8 (0.2)

-0.1

(-0.09- -0.01) 0.029

Body fat%

39.8 (6.4)

0.9

(-0.05-1.92) 0.062

30.7 (5.5)

-0.8

(-2.07-0.47) 0.216

% of fat distributed to the trunk

49.4 (6.5)

2.8

(1.83-3.75) <0.001*

57.6 (5.6)

1.2

(-0.11-2.47) 0.074

Obese

38.4

1.3

(0.98-1.78) 0.068

0.8

(0.51-1.25) 0.324

Sarcopenic

1.3

4.2

(1.78-9.72) 0.001*

1.5

5.7

(1.94-16.91) 0.002*

Sarcopenic obesity

0.2

4.0

(0.56-28.52) 0.167

0.8

5.5

(1.22-25.17) 0.027

Results are expressed as mean (SD) or percentages and as beta (B) or odds ratio (OR) with a 95%-confidence interval (CI) and a p-value.

BMI: body mass index, FMI: fat mass index, LMI: lean mass index, n=number, RA: rheumatoid arthritis, SD: standard deviation

*significant results at the 0.05 false discovery rate for 18 tests, between arthritis patients and non-arthritis controls.

Disclosure: S. A. Turk, None; D. van Schaardenburg, None; M. Boers, None; S. de Boer, None; C. Fokker, None; W. F. Lems, None; M. Nurmohamed, None.

To cite this abstract in AMA style:

Turk SA, van Schaardenburg D, Boers M, de Boer S, Fokker C, Lems WF, Nurmohamed M. Unfavorable Body Composition Already at the Onset of Clinical Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/unfavorable-body-composition-already-at-the-onset-of-clinical-arthritis/. Accessed .

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