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Master Thesis

Dépenses énergétiques et complications nutritionnelles de la polyarthrite rhumatoïde : syndrome métabolique, cachexie rhumatoïde

Abstract : Objectives: Rheumatoid arthritis (RA) is a chronic, inflammatory disease during which modifications of energy expenditure were described. Are these alterations connected with the duration and/or the disease activity? Do they have a part in the appearance of nutritional complications, such as metabolic syndrom (MS) and rheumatoid cachexia (RC)? Methods: Among PR patients (n=57), with variability of activity and duration, the inflammatory activity was assessed by Disease Activity Score 28 VS. The body composition was analysed by DEXA, the energy expenditure was measured by indirect calorimetry and their physical activity by actimetry. The SM was defined according to the International Diabetes Federation criteria and the CR as fat free mass index (FFMI) < 10th percentile and fat mass index (FMI) > 25th percentile. Comparisons were tested by ANOVA for the means and Chi 2 for the effectives. The results were considered significant at p<0,05, and we have investigated a possible association by linear regression. Results: The study included 57 PR (73% women, mean age 57 +/- 10 years) with mean disease duration 3,8 +/-3,0 and disease activity DAS 28 VS 3,0 +/- 1,4. The disease duration was associated with the SM (p=0,014), the insulin resistance HOMA (p<0,001) and with a physical activity METs lower (p=0,03). Patients with high disease activity had a higher insulin resistance (p<0,001) and resting energy expenditure (REE) reported to the FFM (REE/FFM). MS and RC prevalence were 24% and 17,8%, the lack of physical activity (p=0,03) and the corticotherapy (p=0,046) were associated with them, the hypermetabolism differenciated them with a higher ratio REE/FFM in the RC (p=0,008). Conclusion: Our data showed that the sedentariness and the corticotherapy furthered the nutritional complications in the rheumatoid arthritis, suggesting the potential for interventions.
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Master Thesis
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Submitted on : Thursday, November 6, 2014 - 11:55:35 AM
Last modification on : Wednesday, August 23, 2017 - 4:29:22 PM
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Marie Hugo. Dépenses énergétiques et complications nutritionnelles de la polyarthrite rhumatoïde : syndrome métabolique, cachexie rhumatoïde. Médecine humaine et pathologie. 2014. ⟨dumas-01080812⟩

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