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Systemic lupus erythematosus: a systematic review with meta-analysis on muscle strength, muscle mass, and physical function

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Abstract

To perform a systematic review with meta-analysis to verify muscle strength, muscle mass, and physical function of patients with systemic lupus erythematosus (SLE) and compare then with healthy individuals and patients with rheumatoid arthritis (RA). A systematic review with meta-analysis of observational studies published in English up to 2022 was performed using MEDLINE (via PubMed) and other relevant sources. Search strategies were based on pre-defined keywords and medical subject headings. The methodological quality of the studies was assessed using the Newcastle–Ottawa Scale. Mean difference (MD) or standardized mean difference (SMD) and 95% confidence intervals (CI) were combined using a random-effects model. Sensitivity analyses were performed when necessary. The significance level was set at p < 0.05. The systematic review included 19 studies and the meta-analysis included 11 studies. SLE patients appear to have less muscle strength assessed by handgrip than healthy controls (SLE = 21.74 kg; healthy controls = 29.34 kg; p < 0.05). SLE patients seem to have greater strength than patients with RA, but this difference was not statistically significant (RA = 17.24 kg; p = 0.210). However, in the sensitivity analysis, SLE group without deforming arthropathy showed higher muscle strength than the RA (p = 0.0001). SLE patients with deforming arthropathy have lower muscle strength compared to SLE patients without deforming arthropathy (p < 0.01). Muscle mass was similar in SLE patients compared to the RA group and healthy controls (p > 0.05). However, RA patients have a higher BMI than the two groups (p < 0.05). Patients with SLE have regular physical function. Muscle strength is affected in SLE patients. SLE patients with deforming arthropathy have less muscle strength than patients without deforming arthropathies.

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Acknowledgements

We thank Vânia Naomi Hirakata, statistician at the Biostatistics Service of the Hospital de Clínicas de Porto Alegre (HCPA), for her scientific support in our systematic review with meta-analysis. Moreover, we thank the Fundo de Incentivo à Pesquisa e Eventos (FIPE) of the Hospital de Clínicas de Porto Alegre and research support fund of the Society of Rheumatology of Rio Grande do Sul for the financial support.

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Authors and Affiliations

  1. Autoimmune Diseases Laboratory, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Rio Grande Do Sul, Brazil

    Émerson Pena, Leonardo Peterson dos Santos, Rafaela Cavalheiro do Espírito Santo, Silvia Guaresi, Thaís Evelyn Karnopp, Ricardo Machado Xavier & Odirlei André Monticielo

  2. Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 , Porto Alegre, Rio Grande do Sul, Brazil

    Émerson Pena, Leonardo Peterson dos Santos, Rafaela Cavalheiro do Espírito Santo, Silvia Guaresi, Thaís Evelyn Karnopp, Ricardo Machado Xavier & Odirlei André Monticielo

  3. Graduate Program in Medical Science, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Rio Grande Do Sul, Brazil

    Émerson Pena, Leonardo Peterson dos Santos & Thaís Evelyn Karnopp

  4. Research Directorate, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande Do Sul, Brazil

    Vânia Naomi Hirakata

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Supplementary material 1

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Supplementary material 2

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Supplementary material 3

Forest plot of the handgrip strength test comparing studies with patients with systemic lupus erythematosus (SLE) with or without deforming arthropathies; MRAW, raw mean; ES, estimated; I^2, heterogeneity between studies; CI; Confidence Interval. (PNG 552 kb)

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Supplementary material 4

Forest plot of the handgrip strength test excluding two studies with female and male SLE (systemic lupus erythematosus) patients in the same sample. Including the other two studies from the control group and from the group of patients with rheumatoid arthritis (RA). MRAW, raw mean; ES, estimated; I^2, heterogeneity between studies; CI; Confidence Interval. (TIF 1380 kb) (PNG 600 kb)

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Supplementary material 5

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Supplementary material 6

Forest plot comparing different study designs that include the handgrip test from our meta-analysis. MRAW, raw mean; ES, estimated; I^2, heterogeneity between studies; CI; Confidence Interval. (PNG 493 kb)

High resolution image (TIF 1190 kb)

Supplementary material 7

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Supplementary material 8

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Pena, É., dos Santos, L.P., do Espírito Santo, R.C. et al. Systemic lupus erythematosus: a systematic review with meta-analysis on muscle strength, muscle mass, and physical function. Clin Rheumatol 42, 1237–1248 (2023). https://doi.org/10.1007/s10067-023-06516-9

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