Background Rheumatoid arthritis is associated with an increased cardiovascular (CV) risk. There is mounting evidence that inflammation is involved in the pathogenesis thereof (1). An unfavorable body composition is, independently, associated with an increased CV risk, and often present in established arthritis patients. This unfavorable composition is a loss of muscle mass (sarcopenia), in the presence of a stable or even increased (abdominal) fat mass (sarcopenic obesity) (2).
Objectives Currently it is unknown when this unfavorable body composition develops. Therefore, we compared body composition in DMARD-naïve early arthritis patients with non-arthritis controls and explored the association with disease activity and traditional CV risk factors.
Methods A total of 317 consecutive early arthritis patients and 1268 age, gender and ethnicity matched non-arthritis controls (3) had a Dual-energy X-ray absorptiometry scan to assess lean (muscle) mass index (LMI), fat mass index (FMI), fat mass distribution (arms and legs versus trunk) and android to gynoid fat mass ratio. For the obesity definition, the cut offs of Gallaher et al. were applied. For the sarcopenia definition, cut offs based on the control group were applied (mean minus two times SD). In addition, a disease activity score, erythrocyte sedimentation rate, lipid profile (total cholesterol, HDL, LDL and triglycerides) and blood pressure assessments were done.
Results Early arthritis patients (84% fulfilling the 2010 ACR/EULAR criteria) had a significantly lower mean LMI (p<0.01) compared with controls. Female patients had a higher mean FMI (p<0.01) and more fat was distributed to the trunk in patients (females p<0.01, males p=0.07) (table). The prevalence of an unfavorable body composition (i.e. sarcopenia and sarcopenic obesity) was higher than in controls, for females 5.0% versus 1.3%, OR: 4.2, p<0.01 and for males 8.2% versus 1.5%, OR: 5.7, p<0.01 (figure). A higher FMI, more android fat and more fat distributed to the trunk were associated with higher blood pressure and lipid levels (and lower HDL levels). There was no clear relationship between body composition parameters and disease activity.
Conclusions Patients at the clinical onset of arthritis more often have an unfavorable body composition (sarcopenia and sarcopenic obesity) than non-arthritis controls. An unfavorable body composition was associated with higher blood pressure and lipid levels (and lower HDL levels).
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Disclosure of Interest None declared