<p><strong>OBJECTIVE: </strong>We determined the prevalence of sarcopenic obesity in patients with rheumatoid arthritis (RA) using multiple methods and assessed associations with physical functioning.</p>

<p><strong>METHODS: </strong>This study evaluated data from three RA cohorts. Whole-body dual-energy absorptiometry (DXA) measures of appendicular lean mass index (ALMI, kg/m2) and fat mass index (FMI) were converted to age, sex, and race-specific Z-Scores and categorized using a recently validated method and compared it to a widely-used existing method. The prevalence of body composition abnormalities in RA was compared with two reference populations. In the RA cohorts, associations between body composition and change in the Health Assessment Questionnaire (HAQ) and the Short Physical Performance Battery (SPPB) in follow-up were assessed using linear and logistic regression, adjusting for age, sex, race, and study.</p>

<p><strong>RESULTS: </strong>The prevalence of low lean mass and sarcopenic obesity were higher in patients with RA (14.2; 12.6%, respectively) compared with the reference population cohorts (7-10%; 4-4.5%, respectively, all p&lt; 0.05). There was only moderate agreement among methods of sarcopenic obesity categorization (Kappa 0.45). The recently validated method categorized fewer subjects as obese, and many of these were categorized as low lean mass only. Low lean mass, obesity, and sarcopenic obesity were each associated with higher HAQ and lower SPPB at baseline and numerically greater worsening.</p>

<p><strong>CONCLUSION: </strong>RA patients had higher rates of low lean mass and sarcopenic obesity than the general population. The recently validated methods characterized body composition changes differently from traditional methods and were more strongly associated with physical function.</p>

<p><strong>PURPOSE: </strong>We determined associations between adipokines and abnormal body composition in patients with rheumatoid arthritis (RA).</p>

<p><strong>METHODS: </strong>Combining data from three RA cohorts, whole-body dual-energy absorptiometry measures of appendicular lean mass and fat mass indices were converted to age, sex, and race-specific Z-Scores. Lean mass relative to fat mass was determined based on prior methods. Independent associations between body composition profiles and circulating levels of adiponectin, leptin, and fibroblast growth factor(FGF)-21 were assessed using linear and logistic regression models adjusting for demographics and study cohort. We also determined the improvement in the area-under-the-curve (AUC) for prediction of low lean mass when adipokines were added to predictive models that included clinical factors such as demographics, study, and body mass index (BMI).</p>

<p><strong>RESULTS: </strong>Among 419 participants, older age was associated with higher levels of all adipokines while higher C-reactive protein was associated with lower adiponectin levels and higher FGF-21 levels. Greater fat mass was strongly associated with lower adiponectin levels and higher leptin and FGF-21 levels. Higher levels of adiponectin, leptin, and FGF-21 were independently associated with low lean mass. The addition of adiponectin and leptin levels to regression models improved prediction of low lean mass when combined with demographics, study, and BMI (AUC 0.75 v. 0.66).</p>

<p><strong>CONCLUSIONS: </strong>Adipokines are associated with both excess adiposity and low lean mass in patients with RA. Improvements in the prediction of body composition abnormalities suggest that laboratory screening could help identify patients with altered body composition who may be at greater risk of adverse outcomes.</p>

<p><strong>OBJECTIVE: </strong>To compare major depression risk among young adults with childhood-onset and adult-onset systemic lupus erythematosus (SLE), and to determine demographic and health-related predictors of depression.</p>

<p><strong>METHODS: </strong>Young adults with SLE ages 18-45 years (n=546) in the Lupus Outcomes Study completed annual telephone surveys from 2002-2015, including assessment of depression using the Center for Epidemiological Studies Depression Scale (CES-D), and self-report measures of sociodemographics and health characteristics. Childhood-onset SLE (cSLE) was defined as age at diagnosis less than 18 years (N=115). Repeated measures analysis was performed to assess risk for major depression (CES-D≥24) at any point in study, and logistic regression was used to assess for recurrent (present on ≥2 assessments) major depression.</p>

<p><strong>RESULTS: </strong>Major depression was experienced by 47% of the cohort at least once during the 12-year study period. In adjusted analysis, cSLE patients had an increased risk of major depressive episode (OR 1.7, 95% CI 1.0-2.7) and recurrent episodes (OR 2.2, 95% CI 1.2-4.3), compared to participants with adult-onset SLE. Older age, lower educational attainment and physical function, higher disease activity, and history of smoking were associated with an increased depression risk. cSLE patients had a higher risk of major depression across all educational groups.</p>

<p><strong>CONCLUSION: </strong>Young adults with SLE, particularly those with childhood-onset disease, are at high risk for major depression, which is associated with increased disease activity, poorer physical functioning, and lower educational attainment. Early depression intervention in young adults with SLE has the potential to improve both medical and psychosocial outcomes. This article is protected by copyright. All rights reserved.</p>