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Smerilli G, Moscioni E, Sclocco R, Lommano MG, Cipolletta E, Maccarrone V, Farah S, De Angelis R, Salaffi F, Grassi W, Filippucci E, Di Matteo A. Multimodal ultrasound muscle assessment in patients with rheumatic diseases: a patient-based reliability study. Rheumatol Adv Pract 2023; 7:rkad072. [PMID: 37675202 PMCID: PMC10477293 DOI: 10.1093/rap/rkad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023] Open
Abstract
Objectives The aim was to explore the inter-reliability of a newly developed US scanning protocol (multimodal US) for the assessment of different aspects of sarcopenia-related muscle involvement, including muscle mass, muscle quality and muscle stiffness [using point shear-wave elastography (SWE)], in patients with rheumatic and musculoskeletal diseases (RMDs). Methods Quadriceps muscle mass (i.e. muscle thickness), muscle quality (i.e. muscle echogenicity evaluated with both a visual semi-quantitative scale and a dedicated software package for image analysis, ImageJ) and point SWE measurements were obtained by two rheumatologists (blinded to each other's evaluation) in consecutive RMD patients without previous/current myositis or neuromuscular disorders.Inter-reliability was assessed using the intraclass correlation coefficient (ICC) for continuous variables and Cohen's kappa (κ) for categorical variables. Results A total of 45 RMD patients were enrolled [mean age 54.5 (16.0) years, male-to-female ratio 1:1.5, mean BMI 24.6 (4.6) kg/m2], 10 with PsA, 7 RA, 5 AS, 5 PMR, 4 SLE, 4 gout, 4 OA, 3 FM and 3 SSc. The grade of inter-rater reliability was excellent for muscle mass [ICC = 0.969 (0.953 < ICC < 0.979)]. Regarding muscle echogenicity, the agreement was substantial/almost perfect using the visual semi-quantitative scale (weighted linear = 0.793, weighted squared = 0.878) and excellent using ImageJ analysis [ICC = 0.916 (0.876 < ICC < 0.944)]. Finally, a good agreement was obtained for point SWE measurements [ICC = 0.76 (0.712 < ICC < 0.8)]. Conclusion Multimodal US is a novel and reliable tool for the evaluation of different aspects of muscle involvement (muscle mass, muscle quality and muscle stiffness) in RMD patients.
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Affiliation(s)
- Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi, Ancona, Italy
| | - Erica Moscioni
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi, Ancona, Italy
| | - Roberta Sclocco
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Giovanna Lommano
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi, Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi, Ancona, Italy
| | - Vincenzo Maccarrone
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi, Ancona, Italy
| | - Sonia Farah
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi, Ancona, Italy
| | - Rossella De Angelis
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi, Ancona, Italy
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi, Ancona, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi, Ancona, Italy
| | - Andrea Di Matteo
- Department of Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Rheumatology, National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Chen ZT, Jin FS, Guo LH, Li XL, Wang Q, Zhao H, Sun LP, Xu HX. Value of conventional ultrasound and shear wave elastography in the assessment of muscle mass and function in elderly people with type 2 diabetes. Eur Radiol 2023; 33:4007-4015. [PMID: 36648552 DOI: 10.1007/s00330-022-09382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/01/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES We assessed muscle mass and function using ultrasound (US) and shear wave elastography (SWE) for sarcopenia in elderly patients with type 2 diabetes. METHODS There were 84 patients with type 2 diabetes enrolled in this study; of these, 30 had sarcopenia and 54 did not. We measured appendicular skeletal muscle mass index (ASMI), handgrip strength, calf circumference, 6-m walking speed, and 5-time chair stand test. All patients were in the supine position with their knees in straight and bent poses in turn. The US-derived thickness (Tstraight, Tbent), cross-sectional area (CSAstraight, CSAbent), and SWE (SWEstraight, SWEbent) of the rectus femoris muscle (RFM) were measured and the differences (ΔT, ΔCSA, ΔSWE) were calculated. We assessed the correlations of clinical indicators with US and SWE features. We then compared the clinical indicators and US and SWE features between patients with and without sarcopenia to determine independent predictors. Diagnostic models were established based on these independent predictors. RESULTS The ASMI was correlated with Tbent (r = 0.57, p < 0.001) and CSAbent (r = 0.50, p < 0.001). Handgrip strength was correlated with Tbent (r = 0.53, p < 0.001) and CSAbent (r = 0.51, p < 0.001). Between patients with and without sarcopenia, the indicators of age, ΔCSA, and ΔSWE were statically different (all p ≤ 0.001). Based on these results, a diagnostic model for sarcopenia was established with 83.3% sensitivity, 83.3% specificity, and 83.3% accuracy. CONCLUSIONS In elderly people with type 2 diabetes, sarcopenia patients had smaller muscle CSA and less stiffness than non-sarcopenia patients. US and SWE might be useful to screen them. KEY POINTS • Sarcopenia is common in elderly people with type 2 diabetes. • Ultrasound and shear wave elastography might be useful methods for quantitatively assessing muscle mass and strength. • Ultrasound and shear wave elastography might be useful methods for screening sarcopenia in elderly patients with type 2 diabetes.
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Affiliation(s)
- Zi-Tong Chen
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng-Shan Jin
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Le-Hang Guo
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Xiao-Long Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiao Wang
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui Zhao
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Li-Ping Sun
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
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Salaffi F, Carotti M, Poliseno AC, Ceccarelli L, Farah S, Di Carlo M, Giovagnoni A. Quantification of sarcopenia in patients with rheumatoid arthritis by measuring the cross-sectional area of the thigh muscles with magnetic resonance imaging. LA RADIOLOGIA MEDICA 2023; 128:578-587. [PMID: 37120660 PMCID: PMC10182126 DOI: 10.1007/s11547-023-01630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/12/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To determine the utility of cross-sectional area (CSA) measurements on magnetic resonance imaging (MRI), at the level of the thigh muscles, to estimate muscle mass in discriminating rheumatoid arthritis (RA) patients with sarcopenia from those without. MATERIALS AND METHODS Consecutive female RA patients were enrolled for this cross-sectional study. Patients were assessed for disease activity, radiological damage, handgrip strength, physical performance and for the presence of sarcopenia, identified in accordance with the EWGSOP2 criteria. A 1.5 T MRI machine was used to scan the thigh muscles. A dimensional region growth algorithm (Horos™) was used to segment the muscles CSAs (in cm2) on MR images located 25 cm above the knee joint (MRI-CSA-25). The MRI-CSA-25 was obtained by summing the CSAs of the individual muscles. MRI-CSA-25 was correlated (Pearson's r) with the other variables, and its optimal cut-off point (Youden index) for sarcopenia diagnosis was identified in relation to the EWGSOP2 criteria. RESULTS 32 RA female patients were studied, 34.4% diagnosed as sarcopenic. The mean MRI-CSA-25 was 151.00 cm2 for patient with sarcopenia, 275.57 cm2 for patient without sarcopenia (p < 0.001). MRI-CSA-25 correlated significantly with measures of physical performance, and disease activity, but not with radiological damage or age. The MRI-CSA-25 optimal cut-off point in discriminating sarcopenic patients was identified at 182.00 cm2 (AUC-ROC = 0.894). CONCLUSION MRI-CSA-25 can differentiate sarcopenic versus non-sarcopenic RA patients, representing an imaging biomarker of this condition.
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Affiliation(s)
- Fausto Salaffi
- Clinica Reumatologica, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Via Aldo Moro, 25, 60035, Jesi (Ancona), Italy
| | - Marina Carotti
- Dipartimento di Scienze Radiologiche, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Anna Claudia Poliseno
- Dipartimento di Scienze Radiologiche, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Ceccarelli
- IRCCS AOUBO, Pediatric and Adult Cardio-Thoracovascular, Onchoematologic and Emergencies Radiology Unit, Bologna, Italy
| | - Sonia Farah
- Clinica Reumatologica, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Via Aldo Moro, 25, 60035, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Clinica Reumatologica, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Via Aldo Moro, 25, 60035, Jesi (Ancona), Italy.
| | - Andrea Giovagnoni
- Dipartimento di Scienze Radiologiche, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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Di Matteo A, Moscioni E, Lommano MG, Cipolletta E, Smerilli G, Farah S, Airoldi C, Aydin SZ, Becciolini A, Bonfiglioli K, Carotti M, Carrara G, Cazenave T, Corradini D, Cosatti MA, de Agustin JJ, Destro Castaniti GM, Di Carlo M, Di Donato E, Di Geso L, Elliott A, Fodor D, Francioso F, Gabba A, Hernández-Díaz C, Horvath R, Hurnakova J, Jesus D, Marin J, Martire MV, Mashadi Mirza R, Massarotti M, Musca AA, Nair J, Okano T, Papalopoulos I, Rosa J, Rosemffet M, Rovisco J, Rozza D, Salaffi F, Scioscia C, Scirè CA, Tamas MM, Tanimura S, Ventura-Rios L, Villota-Eraso C, Villota O, Voulgari PV, Vreju FA, Vukatana G, Hereter JZ, Zanetti A, Grassi W, Filippucci E. Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study. Front Med (Lausanne) 2023; 9:1090468. [PMID: 36733934 PMCID: PMC9886677 DOI: 10.3389/fmed.2022.1090468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases. Methods Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement ("VAS echogenicity," 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients. Results The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. "VAS echogenicity" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and "VAS echogenicity" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively). Conclusion The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases.
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Affiliation(s)
- Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom,*Correspondence: Andrea Di Matteo,
| | - Erica Moscioni
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Maria Giovanna Lommano
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Sonia Farah
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Carla Airoldi
- Hospital Provincial, Rheumatology, Rosario, Argentina
| | - Sibel Zehra Aydin
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrea Becciolini
- Internal Medicine and Rheumatology Unit, Department of Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Karina Bonfiglioli
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marina Carotti
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Davide Corradini
- Rheumatology Unit, University Clinic AOU Cagliari, Monserrato, CA, Italy
| | - Micaela Ana Cosatti
- CEMIC, Centro de Educación Médica e Investigaciones Médicas “Norberto Quirno”, Buenos Aires, Argentina
| | - Juan Josè de Agustin
- Rheumatology Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Eleonora Di Donato
- Internal Medicine and Rheumatology Unit, Department of Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Luca Di Geso
- Department of Internal Medicine, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Marche, Italy
| | - Ashley Elliott
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Daniela Fodor
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Alessandra Gabba
- Local Health Unit (ASL), Samugheo, OR, Italy,Local Health Unit (ASL), Orosei, NU, Italy
| | - Cristina Hernández-Díaz
- División de Reumatología, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico
| | - Rudolf Horvath
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia
| | - Jana Hurnakova
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia
| | - Diogo Jesus
- Department of Rheumatology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Josefina Marin
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Marco Massarotti
- Department of Rheumatology, University Hospitals Dorset NHS Foundation Trust, Christchurch Hospital, Christchurch, United Kingdom
| | | | - Jagdish Nair
- Department of Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Tadashi Okano
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ioannis Papalopoulos
- Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece
| | - Javier Rosa
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcos Rosemffet
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - João Rovisco
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Davide Rozza
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Crescenzio Scioscia
- Rheumatology Unit, Department of Emergency and Organ Transplants (DETO), University of Bari, Bari, Italy
| | | | - Maria-Magdalena Tamas
- Department of Rheumatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Shun Tanimura
- Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan
| | - Lucio Ventura-Rios
- División de Reumatología, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico
| | - Catalina Villota-Eraso
- IPS Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota, Pasto, Colombia
| | - Orlando Villota
- Division of Rheumatology, Fundación Hospital San Pedro, Pasto, Colombia
| | - Paraskevi V. Voulgari
- Department of Rheumatology, School of Health Science, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Florentin Ananu Vreju
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gentiana Vukatana
- Rheumatology Unit, IRCCS Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
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Di Matteo A, Smerilli G, Cipolletta E, Wakefield RJ, De Angelis R, Risa AM, Salaffi F, Farah S, Villota-Eraso C, Maccarrone V, Filippucci E, Grassi W. Muscle involvement in systemic lupus erythematosus: multimodal ultrasound assessment and relationship with physical performance. Rheumatology (Oxford) 2022; 61:4775-4785. [PMID: 35333315 DOI: 10.1093/rheumatology/keac196] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/21/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The objectives of this study were (1) to explore US findings for muscle mass, muscle quality and muscle stiffness in SLE patients and healthy subjects; (2) to investigate the relationship between the US muscle findings and physical performance in SLE patients and healthy subjects. METHODS Quadriceps muscle thickness was used for assessment of muscle mass, muscle echogenicity (using a visual semi-quantitative scale and grayscale analysis with histograms) for assessment of muscle quality, and point shear-wave elastography (SWE) for assessment of muscle stiffness in 30 SLE patients (without previous/current myositis or neuromuscular disorders) and 15 age-, sex- and BMI-matched healthy subjects. Hand grip strength tests and short physical performance battery (SPPB) tests were carried out in the same populations. RESULTS No difference was observed between SLE patients and healthy subjects for quadriceps muscle thickness (35.2 mm ±s.d. 6.8 vs 34.8 mm ± s.d. 6.0, respectively, P = 0.79). Conversely, muscle echogenicity was significantly increased in SLE patients (visual semi-quantitative scale: 1.7 ± s.d. 1.0 vs 0.3 ± s.d. 0.5, respectively, P < 0.01; grayscale analysis with histograms: 87.4 mean pixels ± s.d. 18.8 vs 70.1 mean pixels ± s.d. 14.0, respectively, P < 0.01). Similarly, SWE was significantly lower in SLE patients compared with healthy subjects {1.5 m/s [interquartile range (IQR) 0.3] vs 1.6 m/s (IQR 0.2), respectively, P = 0.01}. Muscle echogenicity was inversely correlated with grip strength (visual semi-quantitative scale, Rho: -0.47, P = 0.01; grayscale analysis with histograms, Rho: -0.41, p < 0.01) and SPPB (visual semi-quantitative scale, Rho: -0.50, P < 0.01; grayscale analysis with histograms Rho: -0,46, P < 0.01). CONCLUSIONS US assessment of muscle echogenicity and stiffness is useful for the early detection of muscle involvement in SLE patients.
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Affiliation(s)
- Andrea Di Matteo
- Polytechnic University of Marche, Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
| | - Gianluca Smerilli
- Polytechnic University of Marche, Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
| | - Edoardo Cipolletta
- Polytechnic University of Marche, Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Rossella De Angelis
- Polytechnic University of Marche, Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
| | - Anna Maria Risa
- Polytechnic University of Marche, Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
| | - Fausto Salaffi
- Polytechnic University of Marche, Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
| | - Sonia Farah
- Polytechnic University of Marche, Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
| | | | - Vincenzo Maccarrone
- Polytechnic University of Marche, Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
| | - Emilio Filippucci
- Polytechnic University of Marche, Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
| | - Walter Grassi
- Polytechnic University of Marche, Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
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6
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Salaffi F, Carotti M, Di Matteo A, Ceccarelli L, Farah S, Villota-Eraso C, Di Carlo M, Giovagnoni A. Ultrasound and magnetic resonance imaging as diagnostic tools for sarcopenia in immune-mediated rheumatic diseases (IMRDs). Radiol Med 2022; 127:1277-1291. [DOI: 10.1007/s11547-022-01560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/12/2022] [Indexed: 01/10/2023]
Abstract
AbstractSarcopenia is characterized by loss of muscle mass, altered muscle composition, fat and fibrous tissue infiltration, and abnormal innervation, especially in older individuals with immune-mediated rheumatic diseases (IMRDs). Several techniques for measuring muscle mass, strength, and performance have emerged in recent decades. The portable dynamometer and gait speed represent the most frequently used tools for the evaluation of muscle strength and physical efficiency, respectively. Aside from dual-energy, X-ray, absorptiometry, and bioelectrical impedance analysis, ultrasound (US) and magnetic resonance imaging (MRI) techniques appear to have a potential role in evaluating muscle mass and composition. US and MRI have been shown to accurately identify sarcopenic biomarkers such as inflammation (edema), fatty infiltration (myosteatosis), alterations in muscle fibers, and muscular atrophy in patients with IMRDs. US is a low-cost, easy-to-use, and safe imaging method for assessing muscle mass, quality, architecture, and biomechanical function. This review summarizes the evidence for using US and MRI to assess sarcopenia.
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Mc Gettigan N, Hanley M, Skelly F, Dowling J, Dunne R, Morrin MM, McCaffrey N, O'Toole A, Boland K. Impact of a physician-led exercise programme on quality of life, muscle mass and clinical response in inflammatory bowel disease patients during induction with disease-modifying therapy: a study protocol. BMJ Open Gastroenterol 2022. [DOI: 10.1136/bmjgast-2022-000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
IntroductionBiologic and small-molecule therapies have revolutionised the treatment of moderate-to-severe inflammatory bowel disease (IBD). A significant proportion of patients experience early or delayed treatment failure. Patients with IBD with greater visceral obesity are less likely to respond to biologics. Sarcopenia has been identified as a predictor of disease severity and need for rescue therapy in acute severe ulcerative colitis. The aim of this study is to assess the feasibility of a physician-derived exercise programme in patients with IBD commencing biologic or small-molecule therapy in addition to the effect on physical fitness, body composition and objective measures of quality of life, fatigue scores and disease activity.Methods and analysisThis is a randomised controlled feasibility study comparing the effects of a physician-derived exercise programme and standard medical care (biologic/small-molecule therapy) with standard care alone in patients with moderate to severe IBD. Patients with IBD in the intervention group will undergo a structured exercise programme for 20 weeks. Both IBD groups will carry out body composition, disease activity and quality-of-life assessments at baseline, week 12 and week 26. The primary objective is to assess the feasibility of the physician-derived exercise programme in patients with IBD commencing disease-modifying therapies. Secondary endpoints include a change in cardiorespiratory fitness, disease activity/inflammation, fatigue, health-related quality of life outcomes and body composition between the two IBD groups. Exploratory endpoints include validation of anterior thigh ultrasound for sarcopenia screening, assessment of proinflammatory cytokines and markers of immunometabolism.Ethics and disseminationThis study has received ethical approval from the Beaumont Hospital Ethics committee on 22 October 2021 (reference number 21/21). Data generated or analysed during this study will be published as an article and supplementary appendix in relevant medical journals. The data will also be presented at national and international conferences.Trial registration numberNCT05174754.
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Manzano W, Lenchik L, Chaudhari AS, Yao L, Gupta S, Boutin RD. Sarcopenia in rheumatic disorders: what the radiologist and rheumatologist should know. Skeletal Radiol 2022; 51:513-524. [PMID: 34268590 DOI: 10.1007/s00256-021-03863-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 02/02/2023]
Abstract
Sarcopenia is defined as the loss of muscle mass, strength, and function. Increasing evidence shows that sarcopenia is common in patients with rheumatic disorders. Although sarcopenia can be diagnosed using bioelectrical impedance analysis or DXA, increasingly it is diagnosed using CT, MRI, and ultrasound. In rheumatic patients, CT and MRI allow "opportunistic" measurement of body composition, including surrogate markers of sarcopenia, from studies obtained during routine patient care. Recognition of sarcopenia is important in rheumatic patients because sarcopenia can be associated with disease progression and poor outcomes. This article reviews how opportunistic evaluation of sarcopenia in rheumatic patients can be accomplished and potentially contribute to improved patient care.
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Affiliation(s)
- Wilfred Manzano
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA.
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Akshay S Chaudhari
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA
| | - Lawrence Yao
- Department of Radiology, National Institute of Health, Bethesda, MD, 20892, USA
| | - Sarthak Gupta
- Department of Medicine, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, Bethesda, MD, 20892, USA
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA
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Abstract
PURPOSE OF REVIEW To highlight the potential uses and applications of imaging in the assessment of the most common and relevant musculoskeletal (MSK) manifestations in systemic lupus erythematosus (SLE). RECENT FINDINGS Ultrasound (US) and magnetic resonance imaging (MRI) are accurate and sensitive in the assessment of inflammation and structural damage at the joint and soft tissue structures in patients with SLE. The US is particularly helpful for the detection of joint and/or tendon inflammation in patients with arthralgia but without clinical synovitis, and for the early identification of bone erosions. MRI plays a key role in the early diagnosis of osteonecrosis and in the assessment of muscle involvement (i.e., myositis and myopathy). Conventional radiography (CR) remains the traditional gold standard for the evaluation of structural damage in patients with joint involvement, and for the study of bone pathology. The diagnostic value of CR is affected by the poor sensitivity in demonstrating early structural changes at joint and soft tissue level. Computed tomography allows a detailed evaluation of bone damage. However, the inability to distinguish different soft tissues and the need for ionizing radiation limit its use to selected clinical circumstances. Nuclear imaging techniques are valuable resources in patients with suspected bone infection (i.e., osteomyelitis), especially when MRI is contraindicated. Finally, dual energy X-ray absorptiometry represents the imaging mainstay for the assessment and monitoring of bone status in patients with or at-risk of osteoporosis. Imaging provides relevant and valuable information in the assessment of MSK involvement in SLE.
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