rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2021-70-74rsp-2992Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHСостав тела у пациентов с ранним ревматоидным артритомBody composition in patients with early rheumatoid arthritishttps://orcid.org/0000-0002-2024-6927ГорбуноваЮ. Н.GorbunovaYu. N.

Горбунова Юлия Николаевна

115522, Москва, Каширское шоссе, 34а

Yulia Gorbunova

115522, Moscow, Kashirskoye Highway, 34A

yulia0205@yandex.ruhttps://orcid.org/0000-0003-1147-5936КондратьеваЛ. В.KondratyevaL. V.

115522, Москва, Каширское шоссе, 34а

Lyubov V. Kondratyeva

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-5793-4689ПопковаТ. В.PopkovaT. V.

115522, Москва, Каширское шоссе, 34а

Tatiana V. Popkova

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-0961-9785ДёминН. В.DeminN. V.

115522, Москва, Каширское шоссе, 34а

Nikolay V. Demin

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-7418-9369СмирновА. В.SmirnovA. V.

115522, Москва, Каширское шоссе, 34а

Alexander V. Smirnov

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-1598-8360НасоновЕ. Л.NasonovE. L.

115522, Москва, Каширское шоссе, 34а

119991, Москва, ул. Трубецкая, 8, стр. 2

Evgeny L. Nasonov

115522, Moscow, Kashirskoye Highway, 34A

119991, Moscow, Trubetskaya str., 8, building 2

ФГБНУ Научно-исследовательский институт ревматологии им В.А. НасоновойРоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБНУ Научно-исследовательский институт ревматологии им В.А. Насоновой; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияV.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University) Russian FederationRussian Federation2021030320215917074Copyright © Горбунова Ю.Н., Кондратьева Л.В., Попкова Т.В., Дёмин Н.В., Смирнов А.В., Насонов Е.Л., 20212021Горбунова Ю.Н., Кондратьева Л.В., Попкова Т.В., Дёмин Н.В., Смирнов А.В., Насонов Е.Л.Gorbunova Y.N., Kondratyeva L.V., Popkova T.V., Demin N.V., Smirnov A.V., Nasonov E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2992

Цель исследования – уточнить состав тела у больных ранним ревматоидным артритом до начала терапии синтетическими базисными противовоспалительными препаратами, генно-инженерными биологическими препаратами и глюкокортикоидами с помощью двухэнергетической рентгеновской абсорбциометрии и оценить влияние на состав тела воспаления и метаболического синдрома.

Материал и методы

Материал и методы. В исследование включено 37 пациентов (31 женщина, 6 мужчин) с ранним ревматоидным артритом. Контрольную группу составили 19 здоровых доноров без ревматических заболеваний. Пациентам с ревматоидным артритом и группе контроля измеряли объем талии, рост и вес, рассчитывали индекс массы тела. Состав тела определяли с помощью двухэнергетической рентгеновской абсорбциометрии с использованием программы «Всё тело» (“Whole Body “) на аппарате Hologic (США). Наличие метаболического синдрома оценивали по критериям Международной диабетической федерации.

Результаты

Результаты. Пациенты с ранним ревматоидным артритом имели меньшую массу тощей ткани, которая негативно коррелировала с маркерами воспаления (СОЭ, уровень С-реактивного белка). Избыточная масса тела и ожирение диагностированы соответственно у 24 и 27% больных ранним ревматоидным артритом. Пациенты с ревматоидным артритом и метаболическим синдромом имели большие массу тела, индекс массы тела, объем талии и массу жировой ткани, чем больные без метаболического синдрома. С помощью инструментальных методов показано, что при ревматоидным артрите происходит перераспределение жировой массы в организме, преимущественное ее накопление в области туловища и параллельное уменьшение объема мышечной ткани.

Aim of the study was to clarify the body composition in patients with early rheumatoid arthritis before starting therapy with synthetic basic anti-inflammatory drugs, genetically engineered biological drugs and glucocorticoids using dual-energy X-ray absorptiometry and to assess the effect of inflammation and metabolic syndrome on body composition.

Material and methods

Material and methods. The study included 37 patients (31 women and 6 men) with early rheumatoid arthritis. The control group consisted of 19 healthy donors without rheumatic diseases. Patients with rheumatoid arthritis and the control group were measured by waist size, height and weight, and body mass index was calculated. Body composition was determined by means of dual-energy X-ray absorptiometry using the “Whole Body” program on the HOLOGIC device (USA). The presence of metabolic syndrome was assessed according to the criteria of the International Diabetes Federation (IDF).

Results

Results. Patients with early rheumatoid arthritis had less lean tissue mass, which was negatively correlated with inflammatory markers (ESR and C-reactive protein levels). Overweight and obesity were diagnosed in 24% and 27% of patients with early rheumatoid arthritis, respectively. Patients with rheumatoid arthritis and metabolic syndrome had a higher body weight, body mass index, waist size, and adipose tissue mass than patients without metabolic syndrome. With the help of instrumental methods, it is shown that in rheumatoid arthritis there is a redistribution of fat mass in the body, its predominant accumulation in the trunk area and a parallel decrease in the volume of muscle tissue.

Conclusion

Conclusion. Rheumatoid inflammation and metabolic syndrome affect body composition of patients with early rheumatoid arthritis before the start of antirheumatic therapy.

ранний ревматоидный артритожирениеметаболический синдромсостав телатощая и жировая массыдвухэнергетическая рентгеновская абсорбциометрияearly rheumatoid arthritisobesitymetabolic syndromebody compositionlean and fat massdual-energy X-ray absorptiometryИсследование проводилось в рамках выполнения поисковой темы «Персонализированный подход к диагностике и профилактике нарушений углеводного обмена и сердечно-сосудистых осложнений при РА и СКВ» (регистрационный номер АААА-А20-120051490038-7).ReferencesРевматология: Российские клинические рекомендации. Под ред. ЕЛ Насонова. М.: ГЭОТАР-Медиа;2017:464.Nasonov EL (ed.). Rheumatology: Russian Clinical Guidelines. Moscow: GEOTAR-Media;2017:464. (In Russ.).Wolf F, Michaud K. The effect of body mass index on mortality and clinical status in rheumatoid arthritis. Arthritis Care Res. 2012;64(10):1471−1479. doi: 10.1002/acr.21627Wolf F, Michaud K. The effect of body mass index on mortality and clinical status in rheumatoid arthritis. Arthritis Care Res. 2012;64(10):1471−1479. doi: 10.1002/acr.21627Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on sarcopenia in older people. Age Ageing. 2010;39:412−423. doi: 10.1093/ageing/ afq034Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on sarcopenia in older people. Age Ageing. 2010;39:412−423. doi: 10.1093/ageing/ afq034Giles JT, Bartlett SJ, Andersen RE, Fontaine KR, Bathon JM. Association of body composition with disability in rheumatoid arthritis: impact of appendicular fat and lean tissue mass. Arthritis Care Res. 2008;59:1407−1415. doi: 10.1002/art.24109Giles JT, Bartlett SJ, Andersen RE, Fontaine KR, Bathon JM. Association of body composition with disability in rheumatoid arthritis: impact of appendicular fat and lean tissue mass. Arthritis Care Res. 2008;59:1407−1415. doi: 10.1002/art.24109Van Halm VP, Peters M, Voskuyl A, Boers M, Lems WF, Visser M, et al. Rheumatoid arthritis versus type 2 diabetes as a risk factor for cardiovascular disease: a cross-sectional study. Ann Rheum Dis. 2009;68(9):1395−1400. doi: 10.1136/ard.2008.094151Van Halm VP, Peters M, Voskuyl A, Boers M, Lems WF, Visser M, et al. Rheumatoid arthritis versus type 2 diabetes as a risk factor for cardiovascular disease: a cross-sectional study. Ann Rheum Dis. 2009;68(9):1395−1400. doi: 10.1136/ard.2008.094151Kremers HM, Nicola PJ, Crowson CS, Ballman KV, Gabriel SE. Prognostic importance of low body mass index in relation to cardiovascular mortality in rheumatoid arthritis. Arthritis Rheum. 2004;50:3450−3457. doi: 10.1002/art.20612Kremers HM, Nicola PJ, Crowson CS, Ballman KV, Gabriel SE. Prognostic importance of low body mass index in relation to cardiovascular mortality in rheumatoid arthritis. Arthritis Rheum. 2004;50:3450−3457. doi: 10.1002/art.20612Younis S, Rosner I, Rimar D, Boulman N, Rozenbaum M, Odeh M, et al. Weight change during pharmacological blockade of interleukin-6 tumor necrosis factor-α in patients with inflammatory rheumatic disorders: A 16-week comparative study. Cytokine. 2013;61:353−355. doi: 10.1016/j.cyto.2012.11.007Younis S, Rosner I, Rimar D, Boulman N, Rozenbaum M, Odeh M, et al. Weight change during pharmacological blockade of interleukin-6 tumor necrosis factor-α in patients with inflammatory rheumatic disorders: A 16-week comparative study. Cytokine. 2013;61:353−355. doi: 10.1016/j.cyto.2012.11.007Marcora SM, Chester KR, Mittal G, Lemmey AB, Maddison PJ. Randomized phase 2 trial of anti-tumor necrosis factor therapy for cachexia in patients with early rheumatoid arthritis. Am J Clin Nutr. 2006;84:1463−1472. doi: 10.1093/ajcn/84.6.1463Marcora SM, Chester KR, Mittal G, Lemmey AB, Maddison PJ. Randomized phase 2 trial of anti-tumor necrosis factor therapy for cachexia in patients with early rheumatoid arthritis. Am J Clin Nutr. 2006;84:1463−1472. doi: 10.1093/ajcn/84.6.1463Tournadre A, Pereira B, Dutheil F, Giraud C, Courteix D, Sapin V, et al. Changes in body composition and metabolic profile during interleukin 6 inhibition in rheumatoid arthritis. J Cachexia Sarcopenia Muscle. 2017;8:639−646. doi: 10.1002/jcsm.12189Tournadre A, Pereira B, Dutheil F, Giraud C, Courteix D, Sapin V, et al. Changes in body composition and metabolic profile during interleukin 6 inhibition in rheumatoid arthritis. J Cachexia Sarcopenia Muscle. 2017;8:639−646. doi: 10.1002/jcsm.12189Prasad H, Ryan DA, Celzo M, Stapleton D. Metabolic syndrome: definition and therapeutic implications. Postgrad Med. 2012;124(1):21−30. doi: 10.3810/pgm.2012.01.2514Prasad H, Ryan DA, Celzo M, Stapleton D. Metabolic syndrome: definition and therapeutic implications. Postgrad Med. 2012;124(1):21−30. doi: 10.3810/pgm.2012.01.2514Sellen DW. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization Technical Report Series. 1995;854(1):452. doi: 10.1017/S0021932098261359Sellen DW. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization Technical Report Series. 1995;854(1):452. doi: 10.1017/S0021932098261359Messina C, Monaco CG, Ulivie FM, Sardanelli F, Sconfienza LM. Dual-energy X-ray absorptiometry body composition in patients with secondary osteoporosis. Eur J Radiol. 2016;85(8):1493−1498. doi: 10.1016/j.ejrad.2016.03.018Messina C, Monaco CG, Ulivie FM, Sardanelli F, Sconfienza LM. Dual-energy X-ray absorptiometry body composition in patients with secondary osteoporosis. Eur J Radiol. 2016;85(8):1493−1498. doi: 10.1016/j.ejrad.2016.03.018Humphreys JH, Verstappen S, Mirjafari H, Bunn D, Lunt M, Bruce IN, et al. Association of morbid obesity with disability in early inflammatory polyarthritis: Results from the Norfolk Arthritis Register. Arthritis Care Res. 2013;65(1):122−126. doi: 10.1002/acr.21722Humphreys JH, Verstappen S, Mirjafari H, Bunn D, Lunt M, Bruce IN, et al. Association of morbid obesity with disability in early inflammatory polyarthritis: Results from the Norfolk Arthritis Register. Arthritis Care Res. 2013;65(1):122−126. doi: 10.1002/acr.21722Ajeganova S, Andersson ML, Hafstrom I. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: a long-term follow-up from disease onset. Arthritis Care Res. 2013;65(1):78−87. doi: 10.1002/acr.21710Ajeganova S, Andersson ML, Hafstrom I. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: a long-term follow-up from disease onset. Arthritis Care Res. 2013;65(1):78−87. doi: 10.1002/acr.21710Van den Berg R, van der Heijde D, Landewe R, van Lambalgen K, Huizinga T. The METEOR initiative: the way forward for optimal, worldwide data integration to improve care for RA patients. Clin Exp Rheumatol. 2014;32(5):135−140. PMID: 25365103Van den Berg R, van der Heijde D, Landewe R, van Lambalgen K, Huizinga T. The METEOR initiative: the way forward for optimal, worldwide data integration to improve care for RA patients. Clin Exp Rheumatol. 2014;32(5):135−140. PMID: 25365103Klein-Wieringa IR, van der Linden M, Knevel R, Kwekkeboom JC, van Beelen E, Huizinga TW, et al. Baseline serum adipokine levels predict radiographic progression in early rheumatoid arthritis. Arthritis Rheum. 2011;63(9):2567−2574. doi: 10.1002/art.30449Klein-Wieringa IR, van der Linden M, Knevel R, Kwekkeboom JC, van Beelen E, Huizinga TW, et al. Baseline serum adipokine levels predict radiographic progression in early rheumatoid arthritis. Arthritis Rheum. 2011;63(9):2567−2574. doi: 10.1002/art.30449van der Helm-van Mil AH, van der Kooij SM, Allaart CF, Toes RE, Huizinga TW. A high body mass index has a protective effect on the amount of joint destruction in small joints in early rheumatoid arthritis. Ann Rheum Dis. 2008;67(6):769−774. doi: 10.1136/ard.2007.078832van der Helm-van Mil AH, van der Kooij SM, Allaart CF, Toes RE, Huizinga TW. A high body mass index has a protective effect on the amount of joint destruction in small joints in early rheumatoid arthritis. Ann Rheum Dis. 2008;67(6):769−774. doi: 10.1136/ard.2007.078832Wesley A, Bengtsson C, Elkan AC, Klareskog L, Alfredsson L, Wedrén S; Epidemiological Investigation of Rheumatoid Arthritis Study Group. Association between body mass index and anti-citrullinated protein antibody-positive and anti citrullinated protein antibody-negative rheumatoid arthritis: Results from a population-based case-control study. Arthritis Care Res. 2013;65(1):107−112. doi: 10.1002/acr.21749Wesley A, Bengtsson C, Elkan AC, Klareskog L, Alfredsson L, Wedrén S; Epidemiological Investigation of Rheumatoid Arthritis Study Group. Association between body mass index and anti-citrullinated protein antibody-positive and anti citrullinated protein antibody-negative rheumatoid arthritis: Results from a population-based case-control study. Arthritis Care Res. 2013;65(1):107−112. doi: 10.1002/acr.21749Crowson CS, Matteson EL, Davis JM 3rd, Gabriel SE. Contribution of obesity to the rise in incidence of rheumatoid arthritis. Obesity fuels the upsurge in rheumatoid arthritis. Arthritis Care Res. 2013;65(1):71−77. doi: 10.1002/acr.21660Crowson CS, Matteson EL, Davis JM 3rd, Gabriel SE. Contribution of obesity to the rise in incidence of rheumatoid arthritis. Obesity fuels the upsurge in rheumatoid arthritis. Arthritis Care Res. 2013;65(1):71−77. doi: 10.1002/acr.21660Giles JT, Allison MA, Blumenthal RS, Post W, Gelber AC, Petri M, et al. Abdominal adiposity in rheumatoid arthritis. Association with cardiometabolic risk factors and disease characteristics. Arthritis Rheum. 2010;62(11):3173−3182. doi: 10.1002/art.27629Giles JT, Allison MA, Blumenthal RS, Post W, Gelber AC, Petri M, et al. Abdominal adiposity in rheumatoid arthritis. Association with cardiometabolic risk factors and disease characteristics. Arthritis Rheum. 2010;62(11):3173−3182. doi: 10.1002/art.27629Inaba M, Tanaka K, Goto H, Sakai S, Yamada S, Naka H, et al. Independent association of increased trunk fat with increased arterial stiffening in postmenopausal patients with rheumatoid arthritis. J Rheumatol. 2007;34(2):290−295. PMID: 17304655.Inaba M, Tanaka K, Goto H, Sakai S, Yamada S, Naka H, et al. Independent association of increased trunk fat with increased arterial stiffening in postmenopausal patients with rheumatoid arthritis. J Rheumatol. 2007;34(2):290−295. PMID: 17304655.Metsios GS, Stavropoulos-Kalinoglou A, Panoulas VF, Sandoo A, Toms TE, Nevill AM, et al. Rheumatoid cachexia and cardiovascular disease. Clin Exp Rheumatol. 2009;27(9):91−94. PMID: 20149317Metsios GS, Stavropoulos-Kalinoglou A, Panoulas VF, Sandoo A, Toms TE, Nevill AM, et al. Rheumatoid cachexia and cardiovascular disease. Clin Exp Rheumatol. 2009;27(9):91−94. PMID: 20149317Crowson CS, Myasoedova E, Davis JM 3rd, Matteson EL, Roger VL, Therneau TM, et al. Increased prevalence of metabolic syndrome associated with rheumatoid arthritis in patients without clinical cardiovascular disease. J Rheumatol. 2011;38(1):29−35. doi: 10.3899/jrheum.100346Crowson CS, Myasoedova E, Davis JM 3rd, Matteson EL, Roger VL, Therneau TM, et al. Increased prevalence of metabolic syndrome associated with rheumatoid arthritis in patients without clinical cardiovascular disease. J Rheumatol. 2011;38(1):29−35. doi: 10.3899/jrheum.100346Elkan AC, Hakansson N, Frostegard J, Cederholm T, Hafström I. Rheumatoid cachexia is associated with dyslipidemia and low levels of atheroprotective natural antibodies against phosphorylcholine but not with dietary fat in patients with rheumatoid arthritis: A cross-sectional study. Arthritis Res. 2009;11(2):37. doi: 10.1186/ar2643Elkan AC, Hakansson N, Frostegard J, Cederholm T, Hafström I. Rheumatoid cachexia is associated with dyslipidemia and low levels of atheroprotective natural antibodies against phosphorylcholine but not with dietary fat in patients with rheumatoid arthritis: A cross-sectional study. Arthritis Res. 2009;11(2):37. doi: 10.1186/ar2643Chung CP, Oeser AM, Solus JF, Avalos I, Gebretsadik T, Shintani A, et al. Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis. Atherosclerosis. 2008;196(2):756−763. doi: 10.1016/j.atherosclerosis.2007.01.004Chung CP, Oeser AM, Solus JF, Avalos I, Gebretsadik T, Shintani A, et al. Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis. Atherosclerosis. 2008;196(2):756−763. doi: 10.1016/j.atherosclerosis.2007.01.004Zafar ZA, Mahmud TH, Rasheed A, Wagan AA. Frequency of metabolic syndrome in Pakistani cohort of patients with rheumatoid arthritis. J Pak Med Assoc. 2016;66(6):671−676. PMID: 27339567Zafar ZA, Mahmud TH, Rasheed A, Wagan AA. Frequency of metabolic syndrome in Pakistani cohort of patients with rheumatoid arthritis. J Pak Med Assoc. 2016;66(6):671−676. PMID: 27339567Turk SA, van Schaardenburg D, Boers M, de Boer S, Fokker C, Lems WF, et al. An unfavorable body composition is common in early arthritis patients: A case control study. PLoS One. 2018;13(3):е0193377. doi: 10.1371/journal.pone.0193377Turk SA, van Schaardenburg D, Boers M, de Boer S, Fokker C, Lems WF, et al. An unfavorable body composition is common in early arthritis patients: A case control study. PLoS One. 2018;13(3):е0193377. doi: 10.1371/journal.pone.0193377Мясоедова СЕ, Рубцова ОА, Мясоедова ЕЕ. Композиционный состав тела и минеральная плотность кости у женщин при ревматоидном артрите. Клиницист. 2016;10(3):41–46. doi: 10.17650/1818-8338-2016-10-3-41-45Myasoedova SE, Rubtsova OA, Myasoedova EE. Body composition and bone mineral density in women with rheumatoid arthritis. Klinicist = The Clinician. 2016;10(3):41−46. (In Russ). doi: 10.17650/1818-8338-2016-10-3-41-45Добровольская ОВ, Торопцова НВ, Дёмин НВ, Феклистов АЮ, Никитинская ОА. Ожирение и саркопения у больных ревматоидным артритом: одномоментное исследование. Фарматека. 2020;27(4):57–63. doi: 10.18565/pharmateca.2020.4.57-63Dobrovolskaya OV, Toroptsova NV, Demin NV, Feklistov AY, Nikitinskaya OA. Obesity and sarcopenia in patients with rheumatoid arthritis: a single-stage study. Farmateka = Pharmacy. 2020;27(4):57−63. (In Russ). doi: 10.18565/pharmateca.2020.4.57-63Ilich JZ, Kelly OJ, Inglis JE. Osteosarcopenic obesity syndrome: What is it and how can it be identified and diagnosed? Curr Gerontol Geriatr Res. 2016;2016:7325973. doi: 10.1155/2016/7325973Ilich JZ, Kelly OJ, Inglis JE. Osteosarcopenic obesity syndrome: What is it and how can it be identified and diagnosed? Curr Gerontol Geriatr Res. 2016;2016:7325973. doi: 10.1155/2016/7325973Шостак НА, Мурадянц АА, Кондрашов АА. Саркопения и перекрестные синдромы – значение в клинической практике. Клиницист. 2016;10(3):10–14. doi: 10.17650/1818-8338-2016-10-3-10-14Shostak NA, Muradyants AA, Kondrashov AA. Sarcopenia and cross-sectional syndromes – significance in clinical practice. Klinicist = The Clinician. 2016;10(3): 10−14. (In Russ). doi: 10.17650/1818-8338-2016-10-3-10-14

The authors declare that there are no conflicts of interest present.