title: Association of body composition with disability in rheumatoid arthritis: impact of appendicular fat and lean tissue mass.
abstract: OBJECTIVE
  To explore the association of measures of body composition with disability in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Patients with RA underwent total body dual-energy x-ray absorptiometry for measurement of total and regional body fat and lean mass. The associations of measures of fat and lean mass with disability, measured with the Health Assessment Questionnaire (HAQ), were explored for the total cohort and by sex, controlling for pertinent demographic, lifestyle, and RA disease and treatment covariates.
  
  
  RESULTS
  We studied 197 subjects (118 women, 79 men). Median (interquartile range) HAQ score was 0.625 (0.125-1.25) and was significantly higher, indicating worse physical function, in women than in men. HAQ score was strongly correlated with depression, pain, RA duration, duration of morning stiffness, Disease Activity Score in 28 joints, radiographic damage scores, levels of physical and sedentary activities, and body composition, with increasing fat and decreasing lean mass associated with higher HAQ scores. Appendicular fat and lean mass demonstrated the strongest association per kilogram with HAQ. Mean HAQ score was 0.52 units higher for subjects in the highest versus the lowest quartile of appendicular fat mass (P<0.001), and 0.81 units higher for subjects in the lowest versus the highest quartile of appendicular lean mass (P<0.001). Adjusting for demographic and RA characteristics partially attenuated these associations. The joint associations of appendicular fat and lean mass on HAQ were additive without significant interaction.
  
  
  CONCLUSIONS
  Body composition, particularly the amount of fat and lean mass located in the arms and legs, is strongly associated with disability in RA patients.
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA. gilesjont@jhmi.edu
authors.forename: Jon T
authors.initials: JT
authors.lastname: Giles
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Bartlett
authors.forename: Ross E
authors.initials: RE
authors.lastname: Andersen
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Fontaine
authors.forename: Joan M
authors.initials: JM
authors.lastname: Bathon
mesh_terms: D000273:Adipose Tissue; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000503:physiopathology*; D001823:Body Composition; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D015999:Multivariate Analysis; D012307:Risk Factors