Friday, 06 Dec 2019

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Muscle Loss and Frailty in Rheumatic Disease

“If exercise could be purchased in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” —Robert H. Butler, MD, first director of the National Institute on Aging.

At the 2019 ACR annual meeting, several abstracts looked at the importance of myopia (muscle wasting due to illness at any age) and sarcopenia (age related muscle wasting) in the setting of various rheumatologic diseases. 

Frailty is defined as "decreased physiological reserve and resilience” such that when"exposed to a stressor, they are at increased risk for developing disability or dying.”

As rheumatologists, many of our diseases directly affect our patients ability to function, and loss of muscle mass and strength further amplify the negative effects on our patients health: 

Abstract 325 looked at the prevalence of frailty in 523 patients with RA and spondyloarthritis, finding that in a relatively young group with a mean age 55.4 years, that 21.5% of patients with RA and 18.9% with SpA met the criteria for frailty.

Similarly, frailty was seen in 18% of women with lupus only a mean age of 51 (abstract 1600), with higher proportions of sarcopenia in the groups with sarcopenia. 

Abstract 1657 looked at patients with systemic sclerosis, finding that 1 in 3 had sarcopenia. 

Worse yet, loss of muscle appears to be associated with higher inflammatory disease activity. Abstract 476 showed that RA patients with myopia at baseline at baseline had more radiographic progression over a 1 year period, along with higher disease activity and worse overall function. Additionally, the more muscle mass that was lost, the higher likelihood of radiographic progression.

After seeing data on the impact of muscle loss and frailty across the spectrum of our rheumatic diseases, the next step is how to best address this problem directly. For this, I would make the following suggestions:

Start by referring patients to physical therapy, who can more comprehensively assess a patient’s strength, along with concurrent mechanical issues such as balance, mobility, and endurance. If there are any obvious issues that would limit the patients ability to maintain or build muscle strength, these should be addressed first. 

After addressing initial issues, the patient should continue to work with the therapist, with the goal of developing a home exercise program. Many of our patients are not familiar with exercise, but they can often be given simple movements that use their own bodyweight or inexpensive bands to initially build strength. 

From here, you can either encourage patients to continue to progress in these movements, or else join a fitness center or other type of community fitness program.  

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