Optimization of sarcopenia treatment in rheumatoid arthritis and non-alcoholic fatty liver disease by correcting metabolic disorders
Summary. The prevalence of NAFLD, including NASH, among patients with RA is elevated and ranges from 35% to 50%, while the prevalence of sarcopenia among RA patients varies from 15% to 50% depending on the studied population and diagnostic criteria used. Triple comorbidity negatively affects the prognosis of each pathology, increasing the risk of mortality and disability. The aim of this work is to improve the effectiveness of treatment in patients with rheumatoid arthritis and non-alcoholic steatohepatitis associated with sarcopenic syndrome by correcting muscle, fat, and bone metabolism and chronic inflammation syndrome. Research methods. All patients with RA were examined and diagnosed according to the EULAR/ACR 2010 diagnostic criteria, and the NASH diagnostic algorithm according to the unified clinical protocol of the Ministry of Health of Ukraine No. 826 from 06.11.2014. We used the following EWCSOP2 recommended methods for diagnosing sarcopenia: SARC-F questionnaire, bioimpedance analysis, physical performance tests, and dynamometry. Results. 96 patients with rheumatoid arthritis were examined. Sarcopenia was established in 44 cases. In 19 cases, NAFLD was diagnosed in combination with sarcopenia. Comprehensive treatment, including levocarnitine, arginine hydrochloride, cholecalciferol, dosed physical activity, and a high-protein diet, demonstrates high effectiveness in treating sarcopenia in patients with RA and NAFLD compared to basic therapy. Conclusions. Detection of sarcopenia and NAFLD in patients with RA is important, as triple comorbidity leads to more frequent exacerbations and worse course of the underlying disease.
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