Comment on “The effect of disease-modifying anti-rheumatic drugs on skeletal muscle mass in rheumatoid arthritis patients: a systematic review with meta-analysis”
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Abstract We read with great interest the article by Hein et al., which described the meta-analysis study on the impact of disease-modifying anti-rheumatic drugs (DMARDs) therapy on skeletal muscle mass in rheumatoid arthritis (RA) patients. While the data presented are impressive, we add some remarks about methodological issues that should be considered. First, this meta-analysis does not include several necessary studies that have provided data on the relationship between anti-tumor necrosis factor (anti-TNF) therapy and body composition. To make the meta-analysis more comprehensive, it could be necessary to incorporate these studies into this analysis. Second, this study did not employ a representative measure of skeletal muscle mass that was adjusted for body size, such as skeletal muscle mass index (SMI). It is well recognized that skeletal muscle mass varies with body size, particularly height and body mass index. Given the heterogeneity background of body size in the studies included in this meta-analysis, it may be worthwhile to conduct an additional analysis regarding the associations between DMARDs and the adjusted measure of skeletal muscle mass such as SMI, which is recommended in several guidelines when determining and contrasting the quantity of skeletal muscle mass. Third, when determining body composition, several reports show variances between bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DEXA) in RA as well as in general. In this regard, it may not be appropriate to simultaneously perform a meta-analysis of skeletal muscle mass determined by DEXA and BIA. With the issues described above, we conclude by recommending additional investigations to strengthen the arguments presented by this valuable meta-analysis.Keywords:
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Background: Early detection and prevention of sarcopenia are essential for maintaining the functional health of older adults. There is a close association between sarcopenia and physical activity levels. Possible sarcopenia is a precursor to sarcopenia, which can accurately predict sarcopenia
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Sarcopenia is one of geriatric syndromes, characterized by decreased muscle mass accompanied by decreased muscle strength and/or performance. It is more prevalent with increase in age, and the prevalence depends on the criteria applied and the characteristic of the elderly. Sarcopenia has a higher risk of morbidity and mortality in elderly patients. The definition criteria of sarcopenia are still controversial, but diagnostic criteria from the Asian Working Group for Sarcopenia and the European Working Group on Sarcopenia in Older People (EWGSOP) are the most used criteria for clinical practice. Pathogenesis sarcopenia involved a multifactorial process and is divided into intrinsic and extrinsic factors. Risk factors for sarcopenia include constitutional factors, aging, lifestyle, changes in body condition, and chronic diseases. Based on that, sarcopenia is divided into primary and secondary sarcopenia. There are three stage of sarcopenia, which are pre-sarcopenia, sarcopenia, and severe sarcopenia. Nutrition and exercise are the two main pillars to manage sarcopenia.
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Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. It is the major pathway leading to physical frailty, an important geriatric syndrome and an important problem in the elderly population. There are multiple factors leading to sarcopenia and frailty and for preventing them is important to determine the biochemical factors involved. We conducted a study on 143 elderly patients hospitalized during a nine months period. Demographic data were collected and biochemical parameters were determined. Sarcopenia was determined through muscle mass and muscle strength. The average age of the persons included in the study was 77.13 ± 6.30 years, without differences between gender distributions. To assess the relationship between the biochemical parameters and the presence of sarcopenia, the patients were divided into two groups: the group with sarcopenia and the group without sarcopenia. The analysis of the relationships between the presence of sarcopenia and the biochemical parameters determined within the study group, revealed that sarcopenia is correlated with blood glucose (p = 0.002, r = - 0.266), creatinine (p=0.010, r= -0.221) and also creatinine clearance (p=0.017, r=0.207). Biochemical determinations are important in determining sarcopenia and frailty and are of high importance before establishing any measure of treatment or prevention.
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Background: Early detection and prevention of sarcopenia arecritical. There is a close association between sarcopenia and physical activity levels. Possible sarcopenia is a precursor to sarcopenia, which can accurately predict sarcopenia. According to the tertiary prevention system, the diagnosis of possible sarcopenia has significant implications for the early detection of sarcopenia and the reduction of its prevalence.
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Authors of article have recently analyzed the dynamic of body composition of patients with cardiovascular diseases and obesity by bioelectrical impedance analysis. It was found a difference of body composition in different groups of patients.
Bioelectrical Impedance Analysis
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