FRI0083 GLUCOCORTICOID USE IS ASSOCIATED WITH DETERIORATION OF MUSCLE QUALITY AND FUNCTION: FROM THE CHIKARA STUDY
Authors: Y. Yamada, M. Tada, K. Mandai, N. Hidaka, K. Inui, H. Nakamura
Journal: Annals of the Rheumatic Diseases (2020)

Background: We previously reported that glucocorticoid (GC) use was an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis (RA)1. On the other hand, sarcopenia was not associated with deterioration of muscle function (dynapenia)2. Objectives: Factors associated with deterioration of muscle quality and function were prospectively investigated. Methods: Muscle quality and function were examined by measuring power, speed, and balance in standing-up motion using an exercise functional analysis device (BM-220, Tanita, Japan) at baseline and at 2-year follow-up in the prospective, observational CHIKARA study. Associations between changes in these parameters (Δ muscle quality, Δ muscle function) and body composition, disease activity, treatment, physical function, and history of falls and fractures were investigated by univariate and multivariate analyses. Results: Eighty-one RA patients completed the survey. Their average age was 66 years, disease duration was 5.3 years, the simplified disease activity index (SDAI) was 5.3, and the modified Health Assessment Questionnaire (mHAQ) was 0.25 at baseline. Of the patients, 12.3% used GCs at an average dose of 3.08 mg/day over 2 years. The average GC dose was negatively correlated with changes in muscle quality (r=-0.25, p=0.03), power (r=-0.23, p=0.04), and speed (r=-0.24, p=0.03). The SDAI at baseline was negatively correlated with power (r=-0.23, p=0.04) and speed (r=-0.22, p=0.05) (Table 1). No factor was associated with the mHAQ and a history of falls. No independent factor was identified on multiple regression analysis. Table 1. Associations between changes in muscle quality and function and body composition, disease activity, treatment, physical function, and history of falls and fractures Δ muscle quality Δ muscle function power speed balance r p r p r p r p age, years -0.21 0.063 -0.11 0.337 -0.23 0.041 0.18 0.105 GC dose, mg/day -0.25 0.025 -0.23 0.041 -0.24 0.032 -0.02 0.883 CRP, mg/dl 0.01 0.910 0.03 0.781 0.03 0.799 0.20 0.067 MMP-3, ng/ml -0.25 0.022 -0.13 0.249 -0.17 0.134 0.02 0.847 DAS28ESR -0.09 0.441 -0.05 0.665 -0.09 0.435 0.01 0.961 SDAI -0.14 0.216 -0.23 0.041 -0.22 0.048 0.01 0.917 mHAQ -0.13 0.248 -0.04 0.728 -0.06 0.578 -0.06 0.585 SMI, kg/m 2 0.03 0.764 &lt;0.01 0.998 0.03 0.761 0.24 0.034 BMR, kcal/day 0.05 0.278 0.01 0.96 0.11 0.322 0.18 0.111 fall 0.07 0.531 0.12 0.286 0.02 0.871 -0.02 0.852 fracture &lt;0.01 0.973 &lt;0.01 0.989 -0.05 0.677 -0.19 0.097 Δ, changes from baseline; GC, glucocorticoid; CRP, C-reactive protein; MMP-3, matrix metalloproteinase 3; DAS, Disease Activity Score; ESR, erythrocyte sedimentation rate; SDAI, simplified disease activity index; mHAQ, modified Health Assessment Questionnaire; SMI, skeletal muscle index; BMR, basal metabolic rate. Conclusion: GC use was associated with deterioration in muscle quality and function, as well as sarcopenia development. GC use adversely affected muscle mass, quality, and function. In addition, since high disease activity led to low exercise function, disease activity control is important to prevent deterioration of exercise function. References: [1]Y Yamada, M Tada, K Mandai et al. Glucocorticoid use is an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis: from the CHIKARA study. Clin Rheumatol 2020 Jan 14. Epub ahead of print. [2]M Tada, Y Yamada, K Mandai et al. Correlation between frailty and disease activity in patients with rheumatoid arthritis: Data from the CHIKARA study. Geriatr. Gerontol. Int. 2019;19:1220-25. Disclosure of Interests: Yutaro Yamada: None declared, Masahiro Tada: None declared, Koji Mandai: None declared, Noriaki Hidaka: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.