scholarly journals Ultrasonographic and Clinical Assessment of Peripheral Enthesitis in Patients with Psoriatic Arthritis, Psoriasis, and Fibromyalgia Syndrome: The ULISSE Study

2019 ◽  
Vol 46 (8) ◽  
pp. 904-911 ◽  
Author(s):  
Pierluigi Macchioni ◽  
Carlo Salvarani ◽  
Niccolò Possemato ◽  
Marwin Gutierrez ◽  
Walter Grassi ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Examination ◽  
Clinical Evaluation ◽  
Multicenter Study ◽  
Clinical Assessment ◽  
Systemic Therapy ◽  
Fibromyalgia Syndrome ◽  
Power Doppler ◽  
Cross Sectional ◽  
Doppler Examination

Objective.The purpose of the ULISSE study was to evaluate the prevalence of clinical and ultrasonographic (US) entheseal involvement in patients with psoriatic arthritis (PsA), psoriasis, and fibromyalgia syndrome (FMS).Methods.In this cross-sectional multicenter study, patients with PsA and psoriasis (not taking systemic therapy) and FMS underwent a clinical evaluation of the entheses, and a B-mode and power Doppler examination of 6 pairs of entheses.Results.The study analyzed 140 patients with PsA, 51 with psoriasis, and 51 with FMS. Clinical and US examinations were performed in 1960 and 1680 entheses in the PsA group, and 714 and 612 entheses both in the psoriasis group and in the FMS group. In both per-patient and per-enthesis evaluation, the frequency of entheseal tenderness was higher in patients with FMS (92% of the patients and 46% of the entheses, compared with 66%/23% in the PsA group and 59%/18% in the psoriasis group). With US examination, signs of entheseal involvement were more frequent in both the per-patient and per-enthesis evaluation in PsA and psoriasis (about 90% of patients in both the PsA and psoriasis groups and 75% of patients in the FMS group had at least 1 site affected, and 54%, 41%, and 27% of the pairs of entheses in, respectively, PsA, psoriasis, and FMS patients showed at least 1 enthesis involved).Conclusion.The ULISSE study indicated that enthesitis is a common feature in patients with PsA, those with psoriasis, and in those with FMS if only clinical examination is used. US entheseal assessment showed findings more consistent with the 3 disorders.

scholarly journals SAT0415 AGE RELATIONSHIP WITH ULTRASOUND ARTICULAR AND ENTHESEAL INVOLVEMENT IN PSORIATIC ARTHRITIS: CROSS-SECTIONAL STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1160.2-1161
Author(s):  
I. Fairushina ◽  
D. Abdulganieva ◽  
E. Kirillova ◽  
R. Abdrakipov
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Power Doppler ◽  
Severity Index ◽  
Cross Sectional Study ◽  
Blood Biomarkers ◽  
Cross Sectional ◽  
Age Related ◽  
Hs Crp ◽  
Axial Involvement

Background:Detection of subclinical enthesitis and synovitis in psoriatic arthritis (PsA) is prevalent and ultrasound (US) examination is informative tool for it diagnosing. Aging positively affects degenerative changes.Objectives:To study relationship between US articular and entheseal findings with age in patients with PsA.Methods:57 patients were enrolled to study with fulfilled PsA criteria (CASPAR, 2009). Data collection: demographical, clinical (current psoriasis, axial involvement, enthesitis, dactylitis), US (synovitis count (by Grey Scale), Power Doppler(PD)+ synovitis), thickening and hypoechogenicity at enthesis, PD+ enthesitis, entheses with structural components); biological (high sensitive C-reactive protein (hsCRP), Erythrocyte Sedimentation Rate (ESR).US examination included 798 joints and 3078 entheses (bilateral shoulders, acromioclavicular joints, elbows, wrists, hips, knees, ankles; entheses at the projection of these joints (total number - 54). US entheseal findings were fixed according to consensus-based US definition and scoring for enthesitis in spondyloarthritis and PsA (OMERACT US)1.Results:In all 57 patients: male - 25 (43.9%), mean age 43.4±10.3(SD) years (y), PsA duration was 7 (3;10) y, Ps duration 10 (8; 22) y; 53 (41.1%) had axial involvement, 42 (73.7%) dactylitis, 8 (14%) clinical enthesitis, and 56 (98.2 %) skin psoriasis, Psoriasis Activity and Severity Index score 6.4 (2;14.4), Disease Activity in PsA score 18.1 (10.2;26.1), hsCRP 10.1(2.4;21.4), ESR 20 (11.3;31.5).Synovitis count increased with age noticeably (r=0.508, p<0.01), and weak correlation of PD+ synovitis (r=0.262, p=0.049) and age was found. The entheseal thickening and hypoechogenicity and structural findings increased with age respectively (r=0.345, p=0.009; r=0.337, p=0.01). There was no correlation between PD+ enthesitis and age. The assosiation between PD+ enthesitis and blood biomarkers of inflammation (hs-CRP (r=0.364, p=0.008); ESR (p=0.358, p=0.008) was found.Conclusion:Our study found significant relationship between age and US synovitis. Association between age and US entheseal involvement was noted. Only PD+ enthesitis was not related with age in comparison with other US entheseal findings. The presence of PD US signal at enthesitis in association with increased inflammatory blood biomarkers can be evaluated as the sign of disease activity regardless of age and not as age-related lesion in PsA patients.References:[1]Balint PV, Terslev L, Aegerter P et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis.;2018;77(12):1730-1735.Disclosure of Interests:None declared

scholarly journals POS0548 OPTIMAL ASSESSMENT OF THE RHEUMATOID ARTHRITIS ANKLE AND HINDFOOT: A COMPARATIVE STUDY BETWEEN CLINICAL EXAMINATION AND ULTRASONOGRAPHY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 508.2-509
Author(s):  
K. Maatallah ◽  
H. Boussaa ◽  
H. Riahi ◽  
H. Ferjani ◽  
M. Habechi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Examination ◽  
Demographic Data ◽  
Power Doppler ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Therapeutic Decisions ◽  
The Mean ◽  
Foot Disease

Background:Foot disease is a common problem in rheumatoid arthritis (RA). Therapeutic decisions are often based on clinical examination (CE) alone, which can be adversely affected by factors such as deformity, obesity, and peripheral edema. Ultrasonography (US) has previously been shown to be more sensitive than CE for detecting synovitis and tenosynovitis in RA forefeet, but few data exist for the hindfoot and ankle.Objectives:The aim of this study was to compare CE and US for the detection of hindfoot and ankle synovitis and tenosynovitis in patients with established RA.Methods:We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data and disease parameters were collected. CE was performed by a rheumatologist for the presence or absence of tenderness, swelling, and mobility restriction of both ankles. The following tendons were examined for tenosynovitis: tibialis anterior (TA) and posterior (TP), fibularis longus (FL), and brevis (FB) (assessed together). In a second time, US examination of the tibiotalar, talonavicular, and subtalar joints and the same tendons as CE was performed by a blinded radiologist experienced in musculoskeletal imaging using a Philips HD11 device with a high-frequency linear transducer. The presence or absence of synovitis and tenosynovitis was recorded, and the composite synovitis score (power doppler / grayscale ultrasound (PDUS)) was measured for each joint. The US score of each patient was defined by the sum of the composite scores of the joints studied (0-30). A p-value <0.05 was considered significant.Results:Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].Clinical examination of ankles revealed tenderness in 57.4% of cases, swelling in 38.8% of cases, and restriction in the range of motion in 11.1% of cases. TA tenosynovitis was noted in 14.8% of cases, TP tenosynovitis in 22.2% of cases, and FL and FB tenosynovitis in 31.5% of cases.US showed tibiotalar synovitis in 59.3% of cases, talonavicular synovitis in 64.8% of cases, and subtalar synovitis in 46.3% of cases. TA tenosynovitis was noted in 5.6% of cases, TP tenosynovitis in 22.2% of cases, and FB and FL tenosynovitis in 25% and 11.1% of cases respectively.An association was found between clinical tenderness and US synovitis of the tibiotalar joint (p=0.013) and the talonavicular joint (p=0.027). No association was noted between clinical swelling and US synovitis in these joints.No association was noted between clinical and US tenosynovitis of TA (p=0.279), TP (p=0.436), FB (p=0.495) and FL (p=0.315).Conclusion:Clinical examination of RA ankles may be challenging and needs to be coupled with US, which is more sensitive and accurate in the detection of synovitis and tenosynovitis.Disclosure of Interests:None declared

scholarly journals DAPSA and ultrasound show different perspectives of psoriatic arthritis disease activity: results from a 12-month longitudinal observational study in patients starting treatment with biological disease-modifying antirheumatic drugs

RMD Open ◽  
2018 ◽  
Vol 4 (2) ◽  
pp. e000765 ◽  
Author(s):  
Silva Pukšić ◽  
Pernille Bolton-King ◽  
Joseph Sexton ◽  
Brigitte Michelsen ◽  
Tore K Kvien ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Clinical Assessment ◽  
Global Assessment ◽  
Activity Index ◽  
Power Doppler ◽  
Disease Activity Index ◽  
Patient Reported Outcome Measures ◽  
Joint Disease ◽  
Patient Reported

ObjectivesDisease Activity index for PSoriatic Arthritis (DAPSA) (sum score 68/66 tender/swollen joint counts (68TJC/66SJC), patient’s global assessment, pain and C-reactive protein (CRP)) is recommended for clinical assessment of disease activity in patients with psoriatic arthritis (PsA). Ultrasound (US) (grey scale (GS) and power Doppler (PD)) detects inflammation in joints and extra-articular structures. The present objectives were to explore the longitudinal relationships between DAPSA, clinical assessment as well as patient-reported outcome measures (PROMs) with US in patients with PsA initiating biological DMARDs and the associations between DAPSA and US remission.Methods47 patients with PsA were examined at baseline and after 3, 6, 9 and 12 months. Assessments included 68TJC/66SJC, examiner’s global assessment (EGA), PROMs, CRP, erythrocyte sedimentation rate (ESR) and US GS and PD (48 joints, 10 flexor tendons, 14 entheses, 4 bursae). Clinical composite scores and PD sum scores (0=remission) were calculated. Longitudinal associations were explored by generalised estimating equations with linear and logistic regression.ResultsDAPSA was not longitudinally associated to PD. 66SJC, ESR, 28-joint Disease Activity Score, EGA and CRP were longitudinally associated with PD (p<0.001–0.03), whereas the pain-related components of DAPSA (68TJC and pain) as well as PROMs were not associated. At 6–12 months, remission was achieved in 29%–33 % of the patients for DAPSA and 59%–70 % for PD. The association between DAPSA and PD remission was not significant (p=0.33).ConclusionsDAPSA was not associated with US inflammatory findings which indicates that DAPSA and US may assess different aspects of PsA activity.

scholarly journals SAT0439 POWER DOPPLER ULTRASOUND ASSESSMENT OF A1 PULLEY. A NEW TARGET IN PSORIATIC ARTHRITIS?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1176.1-1176
Author(s):  
G. Smerilli ◽  
E. Cipolletta ◽  
M. DI Carlo ◽  
A. DI Matteo ◽  
W. Grassi ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Power Doppler ◽  
Cross Sectional ◽  
Linear Probe ◽  
Single Centre Study ◽  
Magnetic Resonance Imaging Mri ◽  
Us Findings ◽  
Annular Pulleys ◽  
A1 Pulley

Background:In the last few years annular pulleys inflammation has been highlighted as a possible key pathogenetic factor in psoriatic dactylitis, first with magnetic resonance imaging (MRI)1, then, in a very recent paper2, with power Doppler (PD) ultrasound (US). However, the prevalence of PD US inflammation of annular pulleys in psoriatic arthritis (PsA) patients compared to rheumatoid arthritis (RA) patients has not been investigated yet.Objectives:To determine the prevalence of PD US findings indicative of A1 pulley inflammation in PsA patients and in controls with RA and to preliminarily investigate the correlation between A1 pulley inflammation and disease activity (DAPSA).Methods:Consecutive patients with PsA and RA were included in this cross-sectional single-centre study. A rheumatologist recorded demographic and clinical data and in the same day another rheumatologist performed the US examination using a MyLab ClassC (Esaote, Genova, Italy) equipped with a 10-22 MHz linear probe. A1 pulleys of fingers 2ndto 5thwere assessed bilaterally adopting longitudinal and transverse scans. The following pathological US findings were recorded: inflammation of the pulley (defined as the presence of PD signal within a thickened pulley) and tenosynovitis of the digital flexor tendons at finger level according to OMERACT definition.Results:Sixty patients were enrolled: 30 with PsA and 30 with RA. Inflammation of A1 pulley was found in 15 out 240 fingers (6.3%) of 8 (26.7%) PsA patients and in 1 out of 240 fingers (0.4%) of 1 (3.3%) RA patients (p<0.01 and p=0.03 respectively). Both pulley inflammation and tenosynovitis were correlated with DAPSA (Rpb=0.56, p<0.01 and Rpb=0.48, p<0.01). In fact, 7 out 8 (88%) PsA patients with at least one inflamed A1 pulley had a moderate/high disease activity score. The regression linear analysis (R2=0.36, adjusted R2=0.31) showed that A1 pulley inflammation was correlated with higher DAPSA scores (β=0.43, p=0.03). No significant association was reported between A1 pulley inflammation and past or current episodes of dactylitis (p=0.09). However, the only current dactylitis assessed showed A1 pulley inflammation.Conclusion:This pilot study demonstrated that ultrasound A1 pulley inflammation, defined as the presence of power Doppler signal within a thickened pulley, is relatively common at patient level in psoriatic arthritis and seems to be characteristic of PsA compared to RA. In psoriatic arthritis patients, a positive significant correlation was found between ultrasound A1 pulley inflammation and disease activity.References:[1]Tan AL, Fukuba E, Halliday NA, Tanner SF, Emery P, McGonagle D. High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann Rheum Dis 2015; 74: 185-9.[2]Tinazzi I, McGonagle D, Macchioni P, Aydin SZ. Power Doppler enhancement of accessory pulleys confirming disease localization in psoriatic dactylitis. Rheumatology (Oxford) 2019 [Epub ahead of print].Disclosure of Interests:Gianluca Smerilli: None declared, Edoardo Cipolletta: None declared, Marco Di Carlo: None declared, Andrea Di Matteo Grant/research support from: the publication was conducted while Dr. Di Matteo was an ARTICULUM fellow, Walter Grassi Speakers bureau: Prof. Grassi reports personal fees from AbbVie, personal fees from Celgene, personal fees from Grünenthal, personal fees from Pfizer, personal fees from Union Chimique Belge Pharma, outside the submitted work., Emilio Filippucci Speakers bureau: Dr. Filippucci reports personal fees from AbbVie, personal fees from Bristol-Myers Squibb, personal fees from Celgene, personal fees from Roche, personal fees from Union Chimique Belge Pharma, personal fees from Pfizer, outside the submitted work.

scholarly journals Use of Ultrasonography to Discriminate Psoriatic Arthritis from Fibromyalgia: A Post-Hoc Analysis of the ULISSE Study

2021 ◽  
Vol 11 (1) ◽  
pp. 180
Author(s):  
Antonio Marchesoni ◽  
Pierluigi Macchioni ◽  
Stefania Gasparini ◽  
Carlo Perricone ◽  
Fabio Massimo Perrotta ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Fibromyalgia Syndrome ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Power Doppler ◽  
Area Under The Curve ◽  
Principal Component ◽  
Chronic Widespread Pain ◽  
Widespread Pain ◽  
Post Hoc

In psoriatic arthritis (PsA) patients with concomitant chronic widespread pain, the differential diagnosis with fibromyalgia syndrome (FMS) can be challenging. We evaluated whether ultrasound (US) examination of entheseal sites can distinguish pain from (PsA) enthesitis versus FMS. PsA and FMS patients underwent clinical evaluation and gray-scale (GS; B-mode) and power Doppler (PD) US examination of the entheses. At least one enthesis with GS- and PD-mode changes was found in 90% and 59.3% of PsA patients (n = 140) and 62.7% and 35.3% of FMS patients (n = 51), respectively. GS and PD identified changes in 49.5% and 19.2% of the 840 PsA entheses and 22.5% and 7.9% of the 306 FMS entheses, respectively. Receiver operating characteristic curve analysis showed an area under the curve of 0.77 and 0.66 for B- and PD-mode, respectively, 3.5 being the best cut-off GS-score to discriminate the two conditions. Multivariate regression showed that Achilles and proximal patellar tendon enthesitis (B-mode) were strongly associated with PsA (odds ratio, ~2). Principal component analysis (B-mode) confirmed that PsA patients have a higher number of involved entheses and patterns of entheseal involvement than FMS patients. US evaluation of the entheses may help differentiate chronic widespread pain from PsA versus FMS.

scholarly journals Disease Features Associated with a low Disease Impact in Patients with Psoriatic Arthritis: Results of a Cross-Sectional Multicenter Study

2020 ◽  
Author(s):  
Rubén Queiro ◽  
Juan D Cañete ◽  
María Montoro ◽  
Susana Gómez ◽  
Ana Cábez
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Multicenter Study ◽  
Health Assessment ◽  
Multivariate Logistic Regression Analysis ◽  
Joint Involvement ◽  
Cross Sectional ◽  
Patient Reported ◽  
Disease Impact ◽  
The Impact

Abstract Background Patient reported outcomes measures, such as those provided by the the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, have been found to be a reliable indicator of change during treatment, predictive of long-term outcomes, and the impact of psoriatic arthritis (PsA) on patients’ lives. The objective of the study was to describe demographic and clinical characteristics of PsA patients with a low disease impact and to analyze predictive factors for that state.Methods Post-hoc analysis of a cross-sectional multicenter study that included 223 consecutive patients. The Psoriatic Arthritis Impact of Disease (PsAID) questionnaire was used to estimate disease impact. Patients with a PsAID < 4 were considered in low disease impact. Minimal Disease Activity (MDA) response and the Health Assessment Questionnaire (HAQ) were also assessed. The degree of agreement between the different outcomes was addressed by Cohen´s kappa index.Results One hundred and twenty-two (54.7%) patients reached a PsAID <4. Among them, 52.0% and 68.0% presented articular or skin remission, respectively. Almost 75% of patients were in MDA state and 85.2% presented a low disability state according to the HAQ. A moderate concordance between HAQ ≤ 0.5 and PsAID <4 (k=0.53), fair between MDA and PsAID <4 (k=0.36), and moderate between DAPSA remission and PsAID <4 (k= 0.46), was observed. Multivariate logistic regression analysis showed that patients with distal interphalangeal joint (DIP) disease (OR 0.40, 95%CI: 0.20-0.79, p=0.009), family history of PsA (OR 0.25, 95%CI: 0.09-0.72, p=0.010), and higher C-reactive protein (OR 0.92, 95%CI: 0.85-0.99, p=0.036) were significantly less likely to reach a PsAID < 4.Conclusions There is certain discrepancy between disease activity measures and a low impact of disease in PsA. Clinical features (DIP joint involvement), biologic activity, and genetic factors (familial history), seem to be associated with lower odds of reaching a low disease impact.

Comprehensive Clinical Assessment, Radiological and Ultrasound Evaluation of Recumbent Cows with Abdominal Dysfunction

2021 ◽  
Author(s):  
S. Sivaraman ◽  
G. Vijayakumar ◽  
G.A. Balasubramaniam ◽  
S. Dharmaceelan ◽  
P. Selvaraj
Keyword(s):  
Ultrasound Imaging ◽  
Clinical Examination ◽  
Clinical Evaluation ◽  
Clinical Assessment ◽  
Tamil Nadu ◽  
Ultrasound Evaluation ◽  
Research Institute

Background: Our study aimed clinical evaluation of recumbent cows with abdominal dysfunction in and around Namakkal district of Tamil Nadu, India. Methods: A total of 132 recumbent cattle brought to Veterinary Clinical Complex, Veterinary College and Research Institute, Namakkal were subjected to detailed clinical examination, radiography and ultrasonography. Result: The various abdominal dysfunctions noticed in recumbent cows in the present study were peritonitis, reticular disorders, ileus, rumen impaction and rumen lactacidosis. Ultrasound imaging is complementary to clinical evaluation to identify the etiology of recumbent cows with abdominal dysfunctions.

scholarly journals A comparison of clinical examination and ultrasound enthesitis indices in patients with psoriatic arthritis, adjusted for concomitant fibromyalgia

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110038
Author(s):  
Mark Sapsford ◽  
Jobie Evans ◽  
Gavin Clunie ◽  
Deepak Jadon
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Examination ◽  
Cross Sectional Study ◽  
Regression Analyses ◽  
Sectional Study ◽  
Single Centre ◽  
Cross Sectional ◽  
Multivariable Regression ◽  
Multivariable Analyses ◽  
Research Consortium

Objectives: To: (a) determine the extent of ultrasound (US)-detected peripheral enthesitis in a cohort of patients with psoriatic arthritis (PsA); (b) compare this with three clinical examination (CE) enthesitis indices; and (c) determine the effect of concurrent fibromyalgia on the evaluation of enthesitis. Methods: A prospective single-centre cross-sectional study of consecutive outpatients with established PsA undergoing clinical examination for enthesitis and US examination for inflammatory and structural lesions of enthesitis. Multivariable analyses tested for association between US scores, CE enthesitis indices and influence of concurrent fibromyalgia. Results: A total of 106 patients were assessed. Of these, 91/106 (85.8%) had CE enthesitis and 105/106 (99.1%) had ⩾1 US feature of enthesitis. There was a moderate correlation between US entheseal inflammation and both the Leeds Enthesitis Index (LEI) (Spearman rank, r = 0.36) and Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC) ( r = 0.44). US entheseal damage did not correlate with CE enthesitis indices. Twenty-eight (26.4%) patients were classified as having concurrent fibromyalgia, in whom multivariable regression analyses demonstrated no correlation between US scores and CE enthesitis indices. PsA patients without fibromyalgia demonstrated a statistically significant association between both LEI ( r = 0.48, p < 0.0001) and SPARCC ( r = 0.62, p < 0.0001) and US entheseal inflammation. Conclusion: There is a moderate association between US entheseal inflammation, but not damage, and CE enthesitis indices in patients with PsA. The presence of concurrent fibromyalgia is linked with higher CE enthesitis scores, without an increase in US inflammation, suggesting that CE enthesitis indices should be used/interpreted with caution in these patients. Imaging, including US, should be the preferred modality to detect enthesitis in PsA patients with concurrent fibromyalgia.

Effect of cancer cachexia on treatment toxicity in metastatic colorectal cancer patients: Results of a prospective multicenter study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9026-9026 ◽  
Author(s):  
Maximilien Barret ◽  
Cecile Dalban ◽  
Julien Taïeb ◽  
David Malka ◽  
Touraj Mansourbakht ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Muscle Tissue ◽  
Clinical Evaluation ◽  
Multicenter Study ◽  
Whole Body ◽  
Cross Sectional ◽  
Chemotherapy Toxicity ◽  
Number Of Patients ◽  
Grade 3

9026^ Background: Malnutrition reduces tolerance to treatment and survival in numerous cancers, including metastatic colorectal cancer (mCRC). Previous studies have shown that chemotherapy toxicity may be linked to sarcopenia. We evaluated the effect of sarcopenia on chemotherapy toxicity among mCRC patients. Methods: In this prospective, cross-sectional, multicenter study, oncological and nutritional data were collected in all consecutive mCRC patients between March 7th and March 20th 2005 in three hospitals. Computed tomography (CT) images were analysed using Slice-O-Matic software V4.3 (Tomovision) to evaluate cross-sectional areas (cm2) of muscle tissue (MT), visceral and subcutaneous adipose tissue (VAT and SAT). The 3rd lumbar vertebra (L3) was chosen as a reference, since L3 and whole-body measurements are linearly related. Indexed on height, MT, VAT and SAT (cm2/m2), were computed and described, after stratification on sex. In accord with the literature, sarcopenia was defined as MT <55 cm2/m2 for men and <39 cm2/m2 for women. Images were obtained within one month of clinical evaluation. Toxicities were evaluated according to the NCI-CTC, version 3.0, in the two months following clinical evaluation. Results: 53 mCRC patients (72% men (M)), participated in the study. According to body mass index (BMI) only 7% of female patients (F) and 3% M were malnourished (BMI<17 kg/m²), and 93% F and 97% M were of normal weight or overweight (BMI> 25kg/m²). These results are to be compared to the 38% (F) and 82% (M) of patients with sarcopenia. Grade 3-4 toxicities were observed in 28% of the cases, with neurotoxicity in 6%, diarrhea 2%, anemia 2%, neutropenia 9%, and nausea and vomiting 6%. In multivariate analysis including age, sex, BMI, sarcopenia, SAT and VAT, the only factor associated with grade 3-4 toxicity was sarcopenia (OR= 13.55 95% CI [1.08;169.31], p=0.043). Conclusions: In mCRC patients undergoing chemotherapy, low muscle tissue was much more frequently observed (68%) than “visible” malnutrition (4%). Despite the small number of patients included in our study, we showed that sarcopenia was associated with severe chemotherapy toxicity in mCRC.

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