Identification of patients with sarcopenic knee osteostearthritis by ultrasonography, evaluation of functionality, disability and quality of life and examination of sarcopenic findings by electroneuromyography

Introduction: The aim of our study was to identify sarcopenic patients with knee osteostearthritis by ultrasonography and to evaluate them in terms of functionality, disability and quality of life, to examine sarcopenic findings by ENMG (Electroneuromyography) and to compare the effects of these parameters on severe sarcopenic and sarcopenic patients, and to evaluate the effects of sarcopenia in early and advanced stages of knee osteoarthritis. Method: 83 female patients with a clinical and radiological diagnosis of knee osteoarthritis and a diagnosis of sarcopenia according to the Sonographic Thigh Adjustment Ratio algorithm were included in the study. Patients were divided into 2 groups as sarcopenic (n:50) and severely sarcopenic (n:33) according to the STAR algorithm. All sarcopenic patients were diagnosed with knee osteoarthritis according to The American College of Rheumatology 2016 criteria and each knee was grouped as stage 1-2-3,4 according to Kellgren-Lawrence staging. In the assessment of muscle strength of patients hand grip strength, upper-middle arm circumference and calf circumference were recorded as anthropometric measurements; rectus femoris, vastus intermedius muscle thickness, rectus femoris cross-sectional area measurement, vastus lateralis (VL) pennation angle, VL muscle thickness, VL fascicle length, biceps brachii muscle thickness, muscle cross-sectional area and fat thickness were evaluated ultrasonographically. In the evaluation of physical performance, 6-metre walking speed test, timed get-up-and-go test and chair stand test were used. Nerve conduction velocities, latency times, CMAP (combined muscle action potentials) obtained from the right median and femoral nerves were recorded, MUP (motor unit potential) values obtained from biceps brachii and vastus lateralis were recorded. Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne OA Severity Index, Nottingham Healt Profile (NHP), WHODAS-2 (12 items) (World Health Organization Disability Assessment Schedule (WHODAS) 2.0 - 12 item version) and Katz activities of daily living index were applied. Routine blood tests, vitamin D, vitamin B12 and romatoid factor were studied from each participant. According to the ultivariate logistic regression analysis, NHP2, WHODAS2, duration of gonarthrosis diagnosis, high sarc-f screening test score and low N.Medianus CMAP size were determined as risk factors increasing severe sarcopenia. Results: The age, body mass index and education level of the group with severe sarcopenia were significantly higher than the group with sarcopenia (p<0.001, p=0.021, p=0.033, respectively). In the sarcopenia group, the rate of non-steroidal drug use, the rate of osteoporosis, the rate of supportive treatment, and the rate of antiresorbtive use were significantly lower than in the severe sarcopenia group (p<0.001, p=0.001, p=0.001, p=0.01, p=0.008, respectively). Nottingham-Pain, NHP1-PHYSICAL, NHP2, WOMAC, WHODAS2 total scores and Lequesne sub-dimension and total scores of the group with sarcopenia were significantly lower than the scores of those with severe sarcopenia in these parameters (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, respectively). In the group with sarcopenia, the percentage of difficulty in work, 6-metre walking speed, timed get-up-and-go test, chair stand test, the time when they could not do their work completely and the time when they reduced their work, duration of gonarthrosis diagnosis, visual analogue score, VAS-movement, duration of complaints and SARC-F screening test score were significantly lower than the group with severe sarcopenia (p<0.001 in all parameters). In the sarcopenia group, N.Femoralis CMAP duration was significantly lower and N.Medianus CMAP size was significantly higher than the severe sarcopenia group (p=0.047, p=0.016, respectively). The vastus lateralis fascicle length and biceps cross-sectional area of the group with sarcopenia were significantly higher than the group with severe sarcopenia (p=0.004, p=0.027). The Katz value of the group with sarcopenia was significantly higher than the group with severe sarcopenia (p<0.001). The Kellgren-lawrence stage for both knees in the group of patients with severe sarcopenia was significantly higher than the K-L stage in the sarcopenic group (p<0.001). The haemoglobin value of patients with sarcopenia was significantly higher than that of patients with severe sarcopenia (p=0.002). There was a significant difference in age between gonarthrosis stages and patients with gonarthrosis stage 4 were older (p=0.003). A significant difference was observed between patients with different k-l stages in terms of educational status and the educational level was lower in advanced stages (p=0.019). There was a significant difference between patients with different K-L stages in terms of non-steroidal drug use and the rate of use was found to be higher in advanced stages (p=0.025). There was a significant difference between patients with different K-L stages in terms of Nottingham-pain, NHP1-physical, WOMAC and WHODAS2 total scores and lequesne sub-dimension and total scores, and this difference was due to the difference between Stage 4 and the other two stages,those with K-L Stage 4 had a higher score (p=0.003, p=0.001, p<0.001, p=0.003, p<0.001, respectively). Significant differences were observed between patients with different K-L stages in terms of percentage of difficulty in work, duration of gonarthrosis diagnosis, sarc-f screening test score, timed get up and walk test, sit and stand test, VAS-movement, duration of complaints and duration of inability to perform their work completely, those with K-L stage 4 had higher values (p=0.002, p<0.001, p=0.002, p=0.001, p=0.005, p=0.003, p=0.001, p=0.009, respectively). There was a significant difference in the duration of femoralis CMAP between patients with different K-L stages, patients with K-L Stage 4 had a higher duration (p=0.005). Conclusion: We observed that ultrasonography is practical, inexpensive and easily accessible among the methods with predictive value in the determination of sarcopenia and USG stands out with these features. We found that OA patients with severe sarcopenia were older, thinner, weaker, had more limited physical activity levels and had more difficulty in activities of daily living. We determined that sarcopenic gonarthrosis patients with advanced stage in Kellgren Lawrence staging and severe sarcopenic gonarthrosis patients have more functional limitations, pain and low quality of life. We analysed the relationship between electroneuromyographic findings and sarcopenia. We think that our investigations with needle electroneuromyography will shed light for further studies. Keywords: Sarcopenia, severe sarcopenia, osteoarthritis, ultrasonography, electroneuromyography, functionality, disability, quality of life, kellgren Lawrence staging