POS1315 PREVALENCE OF SARCOPENIA IN YOUNG ADULTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background

In the 2019 sarcopenia consensus update (EWGSOP2 [1]) experts emphasize low muscle strength as a key characteristic of sarcopenia, adding low muscle mass to confirm the diagnosis of sarcopenia. Thus, the presence of the first criterion indicates probable sarcopenia, the presence of the first and second criteria confirms the diagnosis of sarcopenia, and the presence of all three criteria indicates severe sarcopenia. There are no available data about severe sarcopenia in young adults with juvenile idiopathic arthritis (JIA).

Objectives

This study aims to assess the prevalence of severe sarcopenia in young patients with JIA.

Methods

To confirm the diagnosis of severe sarcopenia we used dual X-ray absorptiometry (DXA) to assess low muscle mass (cut off points for ASM/height2 <7 kg/m2 for men and <5,67 kg/m2 for women); dynamometry - to determine the low muscle strength (grip strength <27 kg for men, <16 kg for women); gait speed and short physical performance battery (SPPB) to assess physical function (cut off points <8 m/sec and score ≤8, respectively). Patients were divided into two groups according to the presence or absence of all three criteria for severe sarcopenia.

Results

We studied 40 young adults with JIA, including 23 female patients and 17 male patients. The mean age of the patients was 24,4±5 years; the mean age at the onset of the disease was 10,1±4,4 years. Patients were divided into 2 groups according to all three criteria for severe sarcopenia. The first group (I group) included 25 patients with reduced muscle mass, strength, and physical function, and the second group (II group) included 15 patients without criteria of severe sarcopenia. In the I and the II groups mean ASM/height2 was 5,1±0,8 kg/m2 vs 7,7±1,01 kg/m2; p=0,01; handgrip strength 14,8 ±4,8 kg vs 27,1±8,3 kg; p=0,01; gait speed 0,6±0,1 m/sec vs 1,4±0,6 m/sec; p=0,01; SPPB score 6,5±1,5 vs 10,9±1,3; p=0,01. The research found out: the height and weight of patients in the group with severe sarcopenia were lower than in the group without severe sarcopenia (height 1,67±0,07 m vs 1,75±0,08 m; p=0,01; weight 56,1±9,2 kg, 72,0±12,8 kg; p=0,01, respectively). The age of patients was not significantly different between the two groups, but the duration of the disease was longer in the I group 16,4±8,2 vs 9,2±5,3; p=0,01. The data of DXA differed between groups: the patients of I group had statistically reduced total BMD 1,07±0,1 g/cm2 vs 1,15±0,14 g/cm2; ultra-distal radius BMD 0,35±0,1 g/cm2 vs 0,51±0,12 g/cm2; femoral neck BMD 0,85±0,1 g/cm2 vs 1,04±0,2 g/cm2; p=0,01, respectively. Comparing the two groups, we found important differences: the level of ESR was higher in the I group 25,05±18,3 vs 11,5±10,02; p=0,01; the index of disease activity either (DAS28 4,0±1,5 vs 2,7±1,2; JADAS27 15,8±9,2 vs 8,3±4,8; p=0,01, respectively). Articular and extraarticular damage index were higher in I group: JADI-A 5,08±7,3 vs 0,5±0,7; p =0,01; JADI-E 1,7±1,8 vs 0,3±0,6, p=0,02.

Conclusion

The study confirms the presence of severe sarcopenia despite the young age of patients with JIA. Severe sarcopenia occurs in patients with a higher level of inflammatory activity, articular and extraarticular damage, reduced bone mineral density, and longer duration of the disease. Further study of the factors influencing the development of sarcopenia in this category of young patients is required.

References

[1]Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis [published correction appears in Age Ageing. 2019 Jul 1;48(4):601]. Age Ageing. 2019;48(1):16-31

Disclosure of Interests

None declared

AB0746 THE ASSOCIATION BETWEEN PRESARCOPENIA AND BONE MINERAL DENSITY IN ADULT PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Background:

The importance of presarcopenia (low lean mass) in clinical practice is accompanied by a high risk of adverse effects such as early disability, reduced quality of life, and increased mortality.

Objectives:

The aim of the study was to assess the link between bone mineral density (BMD) and the state of the muscular system in adult patients with juvenile idiopathic arthritis (JIA).

Methods:

The study was performed in Oleksandrivska Clinical Hospital of Kyiv, Ukraine, where adult patients were transferred from pediatric rheumatologists. Inclusion criteria: patients aged 18-44 years at the time of signing the informed consent; diagnosis of JIA in childhood, verified according to ILAR criteria, duration of JIA >3 years. According to the European Working Group on Sarcopenia in the Elderly (EWGSOP) 2019, patients with a decrease in muscle mass alone were diagnosed with presarcopenia. The BMD and muscle tissue were determined in standard localizations using dual X-ray absorptiometry (DXA).

Results:

The study included 26 adult patients with JIA, including 10 male patients and 16 female patients. The mean age at the time of examination was 22.3 ± 8.15 years; the mean age at the onset of the disease was 9.04 ± 4.9 years. According to the ILAR classification, patients had the following variants of JIA: 3 patients with RF-negative polyarticular variant, 8 patients with persistent oligoarthritis, 4 patients with extended oligoarthritis, 6 patients with RF-positive polyarthritis variant, and 5 patients with systemic JIA. According to the EWGSOP, 2019 reduced muscle mass was calculated by skeletal muscle index (SMI); the cut-off points were considered by SMI <7 kg/m2 for male, <6 kg/m2 for female. Patients were divided into two groups depending on the presence or absence of presarcopenia. The first group (1-st group) included 16 patients with reduced muscle mass (SMI – 5,22± 0,72 kg/m2), and the second group (2-nd group) included 10 patients without reduced muscle mass (SMI – 8,05± 0,94 kg/m2). It was found that the height and weight of patients in the group of presarcopenia was lower than in the group without a low lean mass (height 1,6±0,07 m vs 1,7±0,09 m, t=-2,53; p=0,01; weight 55,06±8,3 kg, 70,0±10,8 kg, t=-3,9; p=0,0007, respectively). The age of patients (25,3±10,1 and 21,3±5,9 years for 1-st and 2-nd groups respectively) and the duration of the disease (17,1±9,5 and 10,3±6,1 for 1-st and 2-nd groups respectively) did not differ statistically between the groups. The age of the onset of JIA in both groups also did not differ (7,8±4,5 and 11,5±4,1 for the 1-st and 2-nd group respectively). The following data were obtained by DXA. The patients of 1-st group had statistically reduced BMD in the region of femoral neck - 0,927±0,15 g/cm2 vs 1,179±0,13 g/cm2, t=-3,18; p=0,006; total hip - 0,977±0,16 g/cm2 vs 1,184±0,05 g/cm2, t=-3,05, p=0,0080; total body - 1,080±0,1 g/cm2 vs 1,193±0,15 g/cm2, t=-2,19; p=0,03; and ultra-distal radius - 0,286±0,06 g/cm2 vs 0,482±0,11 g/cm2, t=-3,60; p=0,007. The BMD in the region of lumbar spine did not differ in two groups - 1,152±0,16 g/cm2 vs 1,137±0,17 g/cm2, t=0,21; p=0,8. In the group of presarcopenia there was a visible decrease in the level of the metabolite of vitamin 25(OH)D3, but not statistically significant: 15,5±7,3 nmol/l vs 19,7±8,6 nmol/l, t =1,0; p=0,3. The study has strengths such as first described presarcopenia in young adults with JIA and potential limitations such as mono-center study and a small number of patients.

Conclusion:

The BMD in the region of total hip, femoral neck, ultra-distal radius, and total body in patients with decreased muscle mass was significantly lower than in patients without low lean mass.

References:

[1]Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis [published correction appears in Age Ageing. 2019 Jul 1;48(4):601]. Age Ageing. 2019;48(1):16-31

Disclosure of Interests:

None declared

FRI0492 СLINICAL AND LABORATORY DATA AND ALGORITHM OF MANAGEMENT OF ADULT PATIENTS WITH OLIGO-ARTICULAR VARIANTS OF JIA

Background:

The oligo-articular JIA is a disease that begins in childhood and can lead to joint damage and disability in adulthood with significant social losses.

Objectives:

The aim of this study was to evaluate the clinical and laboratory status and to develop an algorithm of managment adult patients with oligo articular variant of JIA, depending on the detection of RF or/and A-CCP, ANA, HLA-B27.

Methods:

The study included 168 adult patients from different regions of Ukraine who were diagnosed with JIA in childhood between 1984 and 2014 without severe comorbidities. Inclusion criteria were: age 16 to 60 years; duration of the disease > 3 years. Among patients with JIA were identified 64 patients with oligo-articular variant: 44 (26,2%) - with persistant oligo-arthritis, and 20 (11,9%) with extended oligo-arthritis. The disease activity was evaluated by DAS28 and JADAS-10. The questionaries SF-36, HAQ, TAS-20, PHQ-9 were analyzed and remote articular JADI-A and extra-articular JADI-E damages were evaluated. Statistical studies were performed using IBM SPPS Statistics version 25.0.0.0 software, the results were considered to be reliable at 5% critical level (P <0.05). The distribution of quantitative variables was tested by the Shapiro-Wilk test. Quantitative variables with a normal distribution were expressed as mean ± SD, quantitative variables that showed a non-normal distribution were expressed with a median (P25-P75), also performed correlative analysis of the variables

Results:

It was found that patients with active JIA in 26.5% have depression according to the PHQ-9, while patients in remission have no signs of depression. Most adult patients with JIA (86.4%) have elevated and high levels of alexithymia. The predictors of JIA remission in adulthood are male sex (OR = 0.453; 95% CI 0.253-3.556); arthritis of more than 3 joints (OR = 0.459; 95% CI 0.347-0.770); wrist arthritis in childhood (OR = 0.082; 95% CI 0.009-0.739) and JADAS-10 in the disease onset (OR = 0.758; 95% CI 0.589-0.896) <6 points, treatment with IB in the history (OR = 0,767; 95% CI 0.054-0.811) and the duration of DMARDS treatment (OR = 0.741; 95% CI 0.636-0.863) > 1.5 years. The negative correlation of JADI-A and the patient’s physical well-being PCS (r = -0.27, p <0.05) and physical functioning (r = -0.24, p < 0.05), pain intensity (r = -0.24, p <0.05), general health (r = -0.24, p <0.05), vital activity (r = -0,19, p <0,05), social functioning (r = -0,27, p <0,05), mental health (r = -0,22, p <0,05) according to SF-36. The severity of extra-articular damages JADI-E correlated with PCS (r = -0.22, p <0.05) and physical functioning (r = -0.28, p<0.05), pain intensity (r = -0.20, p <0.05), general health (r = -0.23, p <0.05), and mental health (r = -0.23, p <0.05), but also had a positive correlation with HAM-A (r = 0.25, p <0.05), depression scale (r = 0.28, p <0.05) and PHQ-9 (r = 0.28, p <0.05). Significantly lower level of physical health was established in patients who requires prosthetics (p <0.001) compared to those who did not need prosthetics.

Conclusion:

Based on the obtained results, algorithms of management of adult patients with JIA oligoarthritis were developed, depending on the detected articular and extra-articular damages and the need for prosthetics and the psychological status.

Disclosure of Interests:

None declared

Using genomic information for management planning of an endangered perennial, Viola uliginosa

Species occupying habitats subjected to frequent natural and/or anthropogenic changes are a challenge for conservation management. We studied one such species, Viola uliginosa, an endangered perennial wetland species typically inhabiting sporadically flooded meadows alongside rivers/lakes. In order to estimate genomic diversity, population structure, and history, we sampled five sites in Finland, three in Estonia, and one each in Slovenia, Belarus, and Poland using genomic SNP data with double-digest restriction site-associated DNA sequencing (ddRAD-seq). We found monophyletic populations, high levels of inbreeding (mean population F SNP = 0.407-0.945), low effective population sizes (N e = 0.8-50.9), indications of past demographic expansion, and rare long-distance dispersal. Our results are important in implementing conservation strategies for V. uliginosa, which should include founding of seed banks, ex situ cultivations, and reintroductions with individuals of proper origin, combined with continuous population monitoring and habitat management.

Long-Term Effects of Articular and Extra-Articular Damage in Adult Patients with Juvenile Idiopathic Arthritis and Different Immunogenic Markers

To assess the long-term effects of juvenile idiopathic arthritis in adulthood, unified diagnostic methods for articular and extra-articular lesions should be used which depend on the juvenile idiopathic arthritis variants, the disease activity and treatment. The objective of the research was to compare the clinical manifestations in adult patients with different juvenile idiopathic arthritis-specific immunogenic markers and to evaluate their impact on the long-term articular and extra-articular damage.Materials and methods. We observed 132 young patients with different juvenile idiopathic arthritis variants. According to genetic/immunological markers the following groups were formed:  Group I - 38 positive human leukocyte antigen B27 patients; Group II - 13 positive antinuclear antibody patients; Group III - 26 positive rheumatoid factor/anti-cyclic citrullinated peptide patients and Group IV - 55 patients with all negative markers. Long-term effects of juvenile idiopathic arthritis were estimated by the articular juvenile arthritis damage index (JADI-A) and the extra-articular juvenile arthritis damage index (JADI-E). Descriptive statistics, the Student’s T-test, the Fisher’s exact test and Mann-Whitney U-test were performed.Results. 70 women and 62 men with the disease duration of 13.6±9.3 years at the age of 24.3±8.3 years were included into the study: 12 (9.1%) patients with positive rheumatoid factor polyarthritis, 30 (22.7%) patients - with negative rheumatoid factor polyarthritis, 32 (24.2%) patients with persistent oligoarthritis, 19 (14.4%) patients with extendent oligoarthritis, 20 (15.2%) patients with entesitis-related arthritis and 19 (14.4%) patients with systemic arthritis; there were no patients with psoriatic arthritis. There were no differences between groups in age, disease-modifying antirheumatic drug cumulative dose, mean dose of prednisolone and quality of life according to the SF-36. In Group I, the delay in the diagnosis was more than one year (18.6±24.2 months). In this group, less painful (p<0.005) and deformed (p<0.01) joints as compared to Group ІІІ, and higher levels of the ESR and C-reactive protein as compared to Group ІV were found, although the Juvenile Arthritis Disease Activity Score index in childhood was lower (p<0.005) as compared to Group ІІ. They received a lower cumulative dose of the glucocorticoids as compared to Group II (p<0.01), respectively. They had lower (p<0.01) JADI-E as compared to Group II (1.31 ± 1.49) and lower (p <0.01) JADI-A as compared to Group III. In Group III, the diagnosis was made the fastest in comparison with other groups (6.4±8.4 months, p<0.05); more painful joints (p <0.05) and ankylosis (p<0.05) were observed as compared to Group I, JADI-A was significantly higher (p<0.05) in Group III as compared to Group I. The most pronounced JADI-A was found in Group III, while in Group I and Group II, this index was the lowest. JADI-E was the most pronounced in Group II, and the most favorable course was found in Group І and Group ІІІ (p<0.05).Conclusions. Presence of anti-cyclic citrullinated peptide/rheumatoid factor in adults with juvenile idiopathic arthritis has negative impact on joint damage (JADI-A) indicating the need for aggressive therapy in both childhood and adulthood. Presences of antinuclear antibodies are associated with more often extra-articular damages in adulthood as compared to other groups.