Risk Factors of Muscle Wasting in Women with Rheumatoid Arthritis: Relevance of the Persistent Failure of Conventional Combination Therapy
Abstract
:1. Introduction
2. Methods
2.1. Study Protocol
2.2. Clinical Assessment
2.3. Body Composition Measurements
2.4. Definition of Study Groups
2.5. Pharmacological Treatment
2.6. Definition of Failure of Combined Therapy with csDMARDs
2.7. Laboratory Determinations of Rheumatoid Factor and Acute-Phase Reactants
2.8. Statistical Analysis
2.9. Ethics
3. Results
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | n = 277 |
---|---|
Age, years | 57.4 ± 10.1 |
Menopause, n (%) | 219 (79.1) |
Hormone replacement therapy, n (%) | 96 (34.7) |
Disease duration, years | 12.9 ± 9.6 |
HAQ-DI score, units | 0.57 ± 0.5 |
Functional disability (HAQ-DI ≥ 0.60), n (%) | 128 (46.2) |
DAS28 score, units | 3.7 ± 1.5 |
-Remission (DAS28-ESR < 2.6); | 73 (26.4) |
-Low (DAS28-ESR 2.6–3.1) | 51 (18.4) |
-Moderate (DAS28-ESR 3.2–5.1) | 104 (37.5) |
-Severe disease activity (DAS28-ESR > 5.1). | 49 (17.7) |
Corticosteroids use, n (%) | 239 (86.3) |
Corticosteroids dose, mg/day | 4.9 ± 2.8 |
Corticosteroids dose/Disease duration ratio, mg/day/years | 64.9 ± 70.9 |
Synthetic-DMARD, n (%) | 270 (97.5) |
-Methotrexate, n (%) | 167 (60.3) |
-Leflunomide, n (%) | 99 (35.7) |
-Sulfasalazine, n (%) | 88 (31.8) |
-Azathioprine, n (%) | 43 (15.5) |
-Chloroquine, n (%) | 41 (14.8) |
Treatment failure with combined csDMARDs, n (%) | 44 (15.9) |
Laboratory variables | |
CRP, mg/L | 17.1 ± 23.7 |
ESR, mm/Hr | 26.4 ± 12.5 |
RF, UI/mL | 157 ± 365.7 |
Body composition and skeletal muscle mass measurement | |
Body mass Index, kg/m2 | 27.8 ± 4.2 |
-Overweight and obesity, n (%) | 203 (73.3) |
Skeletal Muscle Index (SMI), n (%) | 6.03 ± 1.1 |
-Muscle wasting, n (%) | 78 (28.2) |
Variables | RA Normal Skeletal Muscle Mass (SMI ≥ 5.45) n = 199 | RA + Muscle Wasting (SMI < 5.45) n = 78 | p |
---|---|---|---|
Age, years | 56.9 ± 10.8 | 58.6 ± 8.1 | 0.17 |
Age ≥ 50 years old, n (%) | 152 (76.4) | 69 (88.5) | 0.02 |
Alcohol consumption, n (%) | 12 (6) | 4 (5.1) | 0.77 |
Smoking, n (%) | 18 (9) | 5 (6.4) | 0.47 |
Sedentary lifestyle, n (%) | 135 (67.8) | 52 (66.7) | 0.85 |
Menopausal, n (%) | 149 (74.9) | 70 (89.7) | 0.006 |
Hormone replacement therapy, n (%) | 78 (39.2) | 18 (23.1) | 0.01 |
Weight, kg | 68.8 ± 10.4 | 62.3 ± 11.8 | <0.001 |
Body mass Index, kg/m2 | 28.5 ± 4.1 | 25.8 ± 3.9 | <0.001 |
-Overweight or obesity, n (%) | 163 (81.9) | 40 (51.3) | <0.001 |
Hypertension, n (%) | 78 (39.2) | 29 (37.2) | 0.75 |
Diabetes Mellitus, n (%) | 22 (11.1) | 3 (3.8) | 0.06 |
Clinical characteristics | |||
Disease duration, years | 13.03 ± 9.8 | 12.5 ± 9.1 | 0.67 |
HAQ-DI score, units | 0.58 ± 0.5 | 0.53 ± 0.5 | 0.51 |
Functional disability, n (%) | 93 (46.7) | 35 (45.5) | 0.85 |
DAS28 score, units | 3.7 ± 1.5 | 3.7 ± 1.4 | 0.94 |
Disease Activity (DAS28 > 2.6), n (%) | 147 (73.9) | 57 (73.1) | 0.89 |
Corticosteroids use, n (%) | 171 (85.9) | 68 (87.2) | 0.78 |
Corticosteroids dose, mg/day | 4.9 ± 2.9 | 5.1 ± 2.6 | 0.54 |
Synthetic DMARD, n (%) | 193 (97) | 77 (98.7) | 0.67 |
Failure of combined csDMARDs, n (%) | 26 (13.1) | 18 (23.1) | 0.04 |
Laboratory findings | |||
Positive CRP (≥10 mg/L), n (%) | 100 (50.3) | 40 (51.3) | 0.87 |
Elevated ESR (≥20 mm/Hr), n (%) | 116 (58.3) | 47 (60.3) | 0.76 |
Positive RF (≥12 UI/mL), n (%) | 124 (62.3) | 58 (74.4) | 0.06 |
Risk Factors of Low SMI in RA (n = 277) | Forward Method (Stepwise) | ||
---|---|---|---|
OR | 95% CI | p | |
Menopause | 4.45 | (1.86 to 10.64) | 0.001 |
Treatment failure with combined csDMARDs | 2.42 | (1.15 to 5.07) | 0.020 |
Body mass index | 0.81 | (0.75 to 0.87) | <0.001 |
Age (years) | Not in the model | - | - |
Alcohol consumption | Not in the model | - | - |
Smoking | Not in the model | - | - |
Sedentary lifestyle | Not in the model | - | - |
Hormone replacement therapy | Not in the model | - | - |
Diabetes Mellitus | Not in the model | - | - |
Disease duration (years) | Not in the model | - | - |
Corticosteroids dose (mg/day) | Not in the model | - | - |
Disease activity | Not in the model | - | - |
Functional disability | Not in the model | - | - |
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Gomez-Ramirez, E.E.; Ramirez-Villafaña, M.; Gamez-Nava, J.I.; Cons-Molina, F.; Rodriguez Jimenez, N.A.; Saldaña-Cruz, A.M.; Cardona-Muñoz, E.G.; Totsuka-Sutto, S.E.; Ponce-Guarneros, J.M.; Trujillo, X.; et al. Risk Factors of Muscle Wasting in Women with Rheumatoid Arthritis: Relevance of the Persistent Failure of Conventional Combination Therapy. Healthcare 2022, 10, 2004. https://doi.org/10.3390/healthcare10102004
Gomez-Ramirez EE, Ramirez-Villafaña M, Gamez-Nava JI, Cons-Molina F, Rodriguez Jimenez NA, Saldaña-Cruz AM, Cardona-Muñoz EG, Totsuka-Sutto SE, Ponce-Guarneros JM, Trujillo X, et al. Risk Factors of Muscle Wasting in Women with Rheumatoid Arthritis: Relevance of the Persistent Failure of Conventional Combination Therapy. Healthcare. 2022; 10(10):2004. https://doi.org/10.3390/healthcare10102004
Chicago/Turabian StyleGomez-Ramirez, Eli E., Melissa Ramirez-Villafaña, Jorge I. Gamez-Nava, Fidencio Cons-Molina, Norma A. Rodriguez Jimenez, Ana M. Saldaña-Cruz, Ernesto G. Cardona-Muñoz, Sylvia E. Totsuka-Sutto, Juan M. Ponce-Guarneros, Xochitl Trujillo, and et al. 2022. "Risk Factors of Muscle Wasting in Women with Rheumatoid Arthritis: Relevance of the Persistent Failure of Conventional Combination Therapy" Healthcare 10, no. 10: 2004. https://doi.org/10.3390/healthcare10102004