Sarcopenia and rheumatic diseases: is there any connection?

Background:Selenoprotein P (SELENOP) and glutathione peroxidase 3 (GPx) are important selenoproteins that transport selenium in body (SELENOP) and exhibit antioxidative effects [1]. Selenium deficiency can be associated with the development...

Sarcopenia is a syndrome defined by generalized and progressive loss of skeletal muscle mass, strength, and function. Besides affecting elderly population, it is actually common among inflammatory rheumatic diseases (IRD) patients. We performed a systematic literature review with a meta-analysis to investigate the influence of biologic and target synthetic disease-modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) on sarcopenia in IRD. A systematic search has been performed on Pubmed, Scopus, and Web of science. Studies characteristics were collected. Assessment tools were body composition (total lean mass (TLM) and percentage, appendicular skeletal mass (ASM), fat-free mass and index (FFM and FFMI), skeletal mass index (SMI) and segmental lean mass (SLM)), and muscle strength and physical performance tests. Treatment effect defined the difference in change from baseline to the end of follow-up treatment was divided by the pooled SD of the difference. Twenty-two studies on 778 patients receiving bDMARDs/tsDMARDs and 157 controls were reviewed. They investigated rheumatoid arthritis (RA) (N = 14), spondyloarthritis (SpA) (N = 6), psoriatic arthritis (N = 1), and both RA and SpA (N = 1). tsDMARDs were used in one study with no effect on sarcopenia. Ten studies demonstrated that bDMARDs increased significantly muscle measures in 347 patients (44.6%) with a significant increase in TLM (6/15 studies; 57.4%), FFMI (4/6 studies; 59.9%), ASM (2/5 studies; 17.6%), SMI (2/5 studies; 18.1%), and SLM (2/2 studies; 3.6%). bDMARDs showed also a positive effect on handgrip strength in 1/3 of studies (45.2%) and on physical performance in 1/2 of studies (61%). In 1/5 of comparative studies, IRD patients on bDMARDs showed significantly higher increase of TLM in comparison to controls naïve bDMARDs. Regarding diagnosis, positive effect of bDMARDs was seen in 67.4% in SpA versus 49.3% in RA, with a significant increase of TLM, ASM and FFMI in 59.4%, 100%, and 65.2% in SpA versus 54.9%, 24.1%, and 54.8% in RA, respectively. Meta-analysis assessed the effect of bDMARD on TLM in 10 studies. There was no statistically significant difference [SMD - 0.10 (95% Confidence Interval - 0.26 - 0.06; tau2 = 0). Heterogeneity across studies was null, and the 95% confidence interval (index of precision) was equal to the 95% predictive interval. The first systematic literature review showed that bDMARDs have a significant improve effect in nearly half of RA and SpA patients on muscle mass and muscle strength, assessed separately. However, the meta-analysis concluded that bDMARDs have no significant effect on TLM.

Some principles of the development of a clinical database/national register of selected inflammatory rheumatic diseases in the Czech Republic

Objectives: Healthcare service needs have changed with the use of effective treatment strategies. Using data from the modern era, we aimed to explore and compare health service-related direct costs in juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (AxSpA).Methods: We linked a longitudinal, population-based clinical data set from Finland’s largest non-university hospital’s rheumatology clinic with an administrative database on health service-related direct costs in 2014. We compared all-cause costs and costs of comorbidities between adult patients with JIA, PsA, RA, and AxSpA (including ankylosing spondylitis). We also characterized patients with high healthcare resource utilization.Results: Cost distributions were similar between rheumatic diseases (p = 0.88). In adulthood, patients with JIA displayed a similar economic burden to much older patients with other inflammatory rheumatic diseases. A minority were high utilizers: among 119 patients with JIA, 15% utilized as much as the remaining 85%. For PsA (213 patients), RA (1086), and AxSpA (277), the high-utilization proportion was 10%. Both low and high utilizers showed rather low disease activity, but in high utilizers, the patient-reported outcomes were slightly worse, with the most distinct differences in pain levels. Of health service-related direct costs, index rheumatic diseases comprised only one-third (43.6% in JIA) and the majority were comorbidity costs.Conclusions: Patients with JIA, PsA, RA, and AxSpA share similar patterns of healthcare resource utilization, with substantial comorbidity costs and a minority being high utilizers. Innovations in meeting these patients’ needs are warranted.

Temporomandibular disorders in immune-mediated rheumatic diseases of the adult: A systematic review

Background:Rheumatic? is an online symptom checker developed collaboratively by designers, engineers, clinical experts and patients. It is designed to identify individuals at high risk of developing rheumatic diseases and patients...

Juvenile arthritis (JA) is a group of clinically heterogeneous arthritis developing in children under 16 years of age, with a duration of at least 6 weeks, if other joint pathology is excluded. Worldwide, ~2 million children and young people suffer from JA, which allows us to consider it the most common rheumatic disease (RD) in children and choose it as a model for studying the peculiarities of the organisation of medical care for children with RD in order to develop a set of measures to improve its quality and accessibility. The study of the peculiarities of the organisation of medical care for children should include an analysis of clinical manifestations at the onset of the disease, the so-called ‘portrait’ of the patient. The description of the patient's ‘portrait’ for each variant of JA can optimise diagnostic processes, in particular, reduce the patient's ‘pathway’ from disease onset to diagnosis verification and prescription of pathogenetic therapy, which determines the relevance of the present study. Objective. To identify the peculiarities of clinical manifestations (‘portrait’) of juvenile arthritis variants in the Russian Federation. Materials and methods. We conducted a cohort retrospective observational study – analysis of discharge epicrises of 2530 patients with SA living in 8 federal districts, in 84/89 (94%) subjects of the Russian Federation, diagnosed at the age of 0 to 18 years: 1349/2530 (53%) patients were observed in the rheumatology department of the Federal State Institution ‘Children's Health Center’ of the Ministry of Health of Russia, 1181/2530 (47%) – in medical organisations of the subjects of the Russian Federation. Statistical processing of the obtained data was performed using the R-Studio software package version 2022.12.0 (Posit Software, PBC). Results. A total of 702/2530 (28%) and 681/2530 (27%) patients were observed with diagnoses of ‘pauciarticular juvenile arthritis’, ‘juvenile polyarthritis (seronegative)’, respectively. A smaller proportion of the total cohort is represented by patients with JA with systemic onset, juvenile ankylosing spondylitis, juvenile rheumatoid arthritis and JA with psoriasis – 420/2530 (17%), 351/2530 (14%), 200/2530 (8%) and 176/2530 (7%) patients, respectively. Majority of the patients were female – 1585/2530 (63%). 1127/2530 (45%) of the 2530 patients in our sample live in Central Russia – in the Central and Volga Federal Districts – 618/2530 (25%), 509/2530 (20%) patients, respectively. 1403/2530 (55%) patients reside in the Northwestern, Siberian, Ural, Far Eastern, Southern, and North Caucasian federal districts. JA debuted predominantly between 5 and 10 years of age (in 942/2530 (37%) patients), the age of debut of the different variants of JA differing (p = 0.000). The most frequent trigger factor associated with the debut of JA is an infectious disease (p = 0.000). A common symptom for all variants is joint involvement – arthritis at disease debut in the overall cohort was reported in 2349/2530 (92,8%) patients (p = 0.06). Other clinical manifestations in the disease debut are characterised by a different degree of prevalence depending on the variant of JA. ‘Portrait’ of a patient with JA at the onset of the disease, observed in a medical organisation of federal subordination, is characterised by more vivid clinical symptoms, pronounced inflammatory activity. Conclusion. Objective analysis of medical records is a key source of information about the peculiarities of the ‘portrait’ of a patient with JA in the Russian Federation. The identified features of the course of the disease must be taken into account in the development of a set of measures to optimise the processes of medical care for children with JA. The presented data on the ‘portrait’ of the patient should be taken into account in the development of additional education programmes in paediatric rheumatology in order to increase the alertness of – specialists of the first contact, including rheumatologists, with regard to the possible debut of JA in patients with joints, eyes, fever, spotty-papular or linear rash, psoriasis, back pain, which will reduce the time of diagnosis and the start of treatment and, consequently, prevent irreversible damage to organs and systems, and reduce the risk of disability. Key words: juvenile arthritis, juvenile arthritis, “portrait” of a patient, clinical manifestations of juvenile (juvenile) arthritis, medical care for children with rheumatic diseases

The current status of stem cell transplantation in rheumatoid arthritis, juvenile chronic arthritis, systemic lupus erythematosus, and systemic sclerosis are reviewed. From a large European bone marrow transplant registry, a birds' eye view of stem cell transplantation for autoimmune disease can be obtained. Among 43 rheumatoid arthritis patients, 35 juvenile chronic arthritis patients, 34 systemic lupus erythematosus patients, and 58 systemic sclerosis patients who underwent stem cell transplantation, initial responses in most patients were good to excellent. Although initial transplant related mortality was low for rheumatoid arthritis, somewhat higher rates for juvenile chronic arthritis, systemic lupus erythematosus, and systemic sclerosis may be falling with modifications in the stem cell transplantation regimens. In rheumatoid arthritis and systemic lupus erythematosus treatment, the criteria for patient selection are still not clear and the therapeutic regimens for stem cell transplantation (and whether follow-up treatment is necessary) are not fully defined. In juvenile chronic arthritis, responses are encouraging although little fully published data beyond that from the European Bone Marrow Transplant Registry exist. In systemic sclerosis, criteria for patient selection and a limited number of stem cell transplantation regimens have been agreed on and controlled trials are underway.

Evaluating sarcopenia in patients with cirrhosis: The role of muscle function

Patients with rheumatic diseases adhere to COVID-19 isolation measures more strictly than the general population.

Invited Commentary

Significant Loss of Skeletal Muscle Mass Occurs After High-Energy Trauma in Young Adults

Background:In autoimmune diseases that onset during childhood, the gender disparity is typically less pronounced compared to adulthood, likely due to distinct hormonal environments, with estrogen playing a significant role in...

to evaluate the immune response to the SARS-CoV-2 vaccines in adults with immune-mediated rheumatic diseases (IMRDs) in comparison to healthy individuals, observed 1-20 weeks following the fourth vaccine dose. Additionally, to evaluate the impact of immunosuppressive therapies, vaccination schedules, the time interval between vaccination and sample collection on the vaccine's immune response. We designed a longitudinal observational study conducted at the rheumatology department of Hospital de Copiapó. Neutralizing antibodies (Nabs) titers against the Wuhan and Omicron variant were analyzed between 1-20 weeks after administration of the fourth dose of the SARS-CoV-2 vaccine to 341 participants (218 IMRD patients and 123 healthy controls). 218 IMRD patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), systemic vasculitis (VS) and systemic scleroderma (SS) were analyzed. Performing a comparison between the variants, Wuhan vs Omicron, we noticed that there were significant differences (p<0.05) in the level of the ID50, both for healthy controls and for patients with IMRDs. The humoral response of patients with IMRDs is significantly lower compared to healthy controls for the Omicron variant of SARS-CoV-2 (p = 0.0015). The humoral response of patients with IMRDs decreases significantly when the time interval between vaccination and sample collection is greater than 35 days. This difference was observed in the response, both for the Wuhan variant and for the Omicron variant. The IMRDs patients, the humoral response variation in the SARS-CoV-2 vaccine depends on doses and type of vaccine administered, the humoral response times and the treatment that these patients are receiving.

Background:Physical inactivity is the fourth leading cause of death (1) and a risk factor for cardiovascular disease (CVD). Patients with rheumatic diseases (RDs), especially rheumatoid arthritis (RA), report low cardiorespiratory...