MEDIX, God. 27 Br. 147/148  •  Pregledni članak  •  Reumatologija HR ENG

Sarkopenija i osteoporotični prijelomi u starijih bolesnika s reumatoidnim artritisomSarcopenia and osteoporotic fractures in elderly patients with rheumatoid arthritis

Nadica Laktašić Žerjavić, Luka Slivar, Porin Perić

Sarkopenija je gubitak snage i mase skeletnih mišića, progresivni je i generalizirani poremećaj, rezultira smanjenom tjelesnom sposobnošću i povezana je s povećanim rizikom za loše ishode, kao što su gubitak samostalnosti, hospitalizacija, kognitivno oštećenje i smrtni ishod. Primarna sarkopenija razvija se starenjem, a sekundarna se pojavljuje posljedično bolesti, inaktivnosti i malnutriciji. Rizik za sarkopeniju u reumatoidnom artritisu povećava starija dob, dulje trajanje bolesti, funkcionalna onesposobljenost i tjelesna neaktivnost, izražena upala i primjena glukokortikoida, a smanjuje primjena lijekova koji modificiraju tijek bolesti (engl. disease modifying anti-rheumatic drugs, DMARDs). U reumatoidnom artritisu najčešće je gubitak mišićne mase praćen normalnom ili povećanom masom masnoga tkiva, što znači sarkopensku pretilost ili reumatoidnu kaheksiju, a ona povećava rizik za dislipidemiju, dijabetes i kardiovaskularne bolesti. Gubitak cjelokupne tjelesne građe, tj. mišićnog i masnoga tkiva, nastupa u dugotrajnome uznapredovalomu stadiju reumatoidnog artritisa i kod bolesti refraktarne na liječenje, a povezan je s upalom. U prevenciji i liječenju sarkopenije najvažnije su vježbe snaženja, tjelesna aktivnost, pravilna prehrana, a može pomoći i nadoknada vitamina D te kontrola udruženih bolesti.

Ključne riječi:
mišićna snaga; osteopororoza; reumatoidni atritis; sarkopenija; tjelesna sposobnost

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 27 Br. 147/148

Sarcopenia (SP) is a loss of mass and strength of skeletal muscles. It is a progressive and generalized skeletal muscle disorder that is associated with a physical disability, and is associated with an increased risk of poor outcomes such as loss of independence, hospitalization, cognitive impairment, and death. Primary SP develops with aging, while secondary SP is a consequence of disease, inactivity, or malnutrition. The risk of SP in rheumatoid arthritis (RA) is increased by older age, longer disease duration, and by the use of glucocorticoids, while it is decreased by the use of disease-modifying antirheumatic drugs. In RA, muscle mass loss is most often accompanied by normal or increased adipose tissue mass, meaning sarcopenic obesity or rheumatoid cachexia, and it increases the risk of dyslipidemia, diabetes, and cardiovascular diseases. Loss of overall body composition, i.e. muscle and fat tissue, occurs in the long-term advanced stage of RA and in RA refractory to treatment, and is associated with inflammation. In the prevention and treatment of SP, the most important are strength exercises, physical activity, proper nutrition, and vitamin D supplementation and control of associated diseases can also help.

Key words:
muscle strength; osteoporosis; physical performance; rheumatoid arthritis; sarcopenia