November 10-15

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ACR Convergence 2023

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Lack of diagnostic definitions represents major obstacle to treating sarcopenia in rheumatic disease


3 minutes

A Wednesday ARHP session will provide an update on sarcopenia research, diagnosis, and treatment, with a focus on the development of criteria that could be applied universally to help identify the issue that can have serious implications on patient well-being and everyday life.

Robert R. McLean, DSc, MPH

“Everyone, even world-class athletes, experiences loss of muscle mass and strength starting in the fourth decade of life,” said Robert R. McLean, DSc, MPH, Assistant Professor of Medicine at Harvard Medical School and the Hebrew SeniorLife Institute for Aging Research in Boston. “But this process is accelerated in many rheumatic diseases primarily due to elevated inflammatory status, which is catabolic to muscle.”

Muscle loss, he said, could also result from decreases in physical activity that may be due to pain or other comorbidities, or even from changes to one’s diet.

Dr. McLean will discuss sarcopenia and related issues during Update: Sarcopenia in Rheumatic Disease, which takes place from 9:00 – 10:00 am Wednesday. He said that is among the biggest challenges currently with management of sarcopenia is its diagnosis.

“Although many definitions of sarcopenia have been proposed and used in research studies, there are currently no consensus criteria to determine low muscle mass or weakness,” he said.

Possible diagnostic aides include the use of dual-energy x-ray absorptiometry (DXA scanning), which is also used to determine bone density. This modality can determine lean muscle mass, as well. Other simple measures of muscle strength are also commonly used, but “specific, clinically meaningful cut-points for these measures have not been established,” Dr. McLean said.

Once a sarcopenia diagnosis is established, few treatments have proved effective in pushing back at the complication. Resistance exercise, Dr. McLean said, is the only such intervention that can consistently improve muscle mass and strength.

“Right now, I think the best we can do is to ensure that patients are participating in these activities and maintaining a healthy diet that includes plenty of protein,” he said.

The session will also feature some discussion of various active areas of research into sarcopenia, in particular a large effort aimed at firmly establishing parameters for its diagnosis. That effort is a collaboration between the National Institute on Aging and other organizations. The collaborators hope to arrive at a consensus on validated diagnostic criteria and how they should be used in clinical practice.

“While these efforts are borne out of the field of aging research, this groundbreaking work will promote similar advances in other patient groups, including the rheumatic diseases,” Dr. McLean said.

Among the criteria that have been proposed include a grip strength cutoff, appendicular lean mass, and walking speed; the specific cutoff points will still need to be validated in further trials.

“I’m hoping that attendees will understand that changes in muscle health in rheumatic disease have a profound impact on clinical outcomes, particularly disability,” Dr. McLean said.

Update: Sarcopenia in Rheumatic Disease
9:00 – 10:00 am Wednesday • Room 204A