Research Article: Sarcopenia in osteoarthritis and rheumatoid arthritis: The association with self-reported fatigue, physical function and obesity

Date Published: June 6, 2019

Publisher: Public Library of Science

Author(s): Lara Vlietstra, Simon Stebbings, Kim Meredith-Jones, J. Haxby Abbott, Gareth J. Treharne, Debra L. Waters, Stephen E. Alway.


To determine if there is an association between sarcopenia, physical function and self-reported fatigue in osteoarthritis (OA) and rheumatoid arthritis (RA).

A cross-sectional analysis of measurements from a cohort of 157 participants with OA or RA was performed. The relationship between muscle mass (appendicular muscle index (AMI)), physical function (timed up and go, 30-seconds sit-to-stand test, 40-meter fast-paced walk test and grip-strength) and two fatigue measures (Multidimensional Assessment of Fatigue (MAF) and a fatigue Visual Analogue Scale (VAS)) was explored using hierarchical linear regression or logistic regression with established AMI cut-offs for sarcopenia.

There were no significant differences for perceived fatigue-related variables between OA or RA sarcopenic or non-sarcopenic participants. Participants with OA had worse physical function (TUG; P = 0.029, STS; P = 0.004, WS; P = 0.003), but participants with RA had lower grip strength (P<0.001). The RA group had higher CRP (P = 0.006), were more likely to receive glucocorticoids (P<0.001), and experienced worse fatigue (P = 0.050). The hierarchical multiple regression showed that self-reported fatigue (VAS/MAF-distress) had a significant but weak association with AMI in RA. Participants with higher percentage body fat had a significantly stronger association with sarcopenia in both OA and RA. Sarcopenia, when assessed by AMI, does not appear to be strongly associated with self-reported fatigue or physical function in participants with either OA or RA. Higher body fat had a moderately strong association with sarcopenia in this cross-sectional study, suggesting that body composition may be an important factor in the health of patients with longstanding OA or RA.

Partial Text

Sarcopenia is defined as the loss of skeletal muscle mass and strength, both of which are subject to a gradual age-related decline [1]. Progressive loss of muscle mass begins as early as 40 years of age and has been estimated at about 8.0% per decade until the age of 70 years [2]. After reaching 70, this loss increases to 15.0% every decade [2] and can eventually result in a 50.0% loss in muscle mass by the age of 80 [3]. A systematic review on the prevalence of sarcopenia by the European Working Group on Sarcopenia in Older People (EWGSOP) reported a prevalence in general community-dwelling older adults of up to 29% [4]. Some major health-related outcomes associated with sarcopenia include osteoporosis [5], obesity [6], dementia [7], type 2 diabetes [8] and lower health-related quality of life [5]. These comorbidities are also detrimental to the overall health of people with osteoarthritis (OA) and rheumatoid arthritis (RA) and result in worse outcomes for patients with these forms of arthritis [9]. Previous research suggests that sarcopenia is common in patients with OA [10] and RA, [11–13] but further research is required to test correlations of sarcopenia in these patients.

The results of this research suggest that sarcopenia is not strongly associated with self-reported fatigue in either OA or RA. However, significant associations between physical function and inflammatory measures and sarcopenia were apparent in both OA and RA participants. Furthermore, higher percentage body fat was significantly association with sarcopenia in both OA and RA participants. These findings have added to the limited knowledge about correlations of sarcopenia in these populations and have potential clinical implications for the screening and provision of care in rheumatology.

In conclusion, sarcopenia, assessed by AMI, does not appear to be strongly associated with self-reported fatigue based on the findings of this cross-sectional study. However, a high percentage body fat was significantly associated with sarcopenia in both types of arthritis, which is an important association that deserves further exploration. Future longitudinal research with larger purposive subsamples of OA and RA patients with sarcopenia, is needed to confirm these findings. In clinical practice the possibility of sarcopenia should be considered in patients who are obese, who are treated with glucocorticoids, or who have unsuppressed inflammation.




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