Sarcopenia as a Feature of Musculoskeletal Manifestations of Pediatric Crohn’s Disease
Bibliographic record
Abstract
Objectives Musculoskeletal (MSK) manifestations are the most common extraintestinal manifestation (EIM) of Crohn’s disease (CD), which include arthralgias, axial/peripheral arthritis, enthesitis, tenosynovitis and dactylitis. CD is associated with impaired nutritional status which can lead to unintentional loss of skeletal muscle mass, known as sarcopenia. Few studies report on sarcopenia in pediatric CD, but it is estimated to affect up to one-third of patients and may be associated with more treatment-refractory disease and poorer quality of life.[1] This study aims to investigate the prevalence of sarcopenia in pediatric CD patients with MSK EIM compared to CD patients without MSK EIM and to evaluate CD-related clinical outcomes. Methods In this single-center, retrospective cohort study, data were collected from 139 newly diagnosed (< 1 year) pediatric CD patients who had undergone magnetic resonance enterography (MRE) at the Children’s Hospital, London Health Sciences Center over 4 years (2019-2023). Bowel disease activity was assessed by weighted pediatric Crohn’s disease activity index (wPCDAI) scores. Sarcopenia was assessed, by an MSK-trained radiologist, by measuring total psoas muscle area (tPMA) from MRE images and comparing to age and sex-matched reference values.[2] Sarcopenia was defined as a tPMA z-score less than – 2.0. Univariate descriptive statistics were used. Results 139 patients with CD were included (mean age 13.1 ± 3.1 years, 59% male). Sarcopenia was found in 22 patients (15.8%). Children with sarcopenia had higher wPCDAI scores (p=0.033), higher ESR (p=0.035), lower hemoglobin (Hb) (p<0.001) and a higher number of hospital admissions (p=0.041) compared to children without sarcopenia. Fifty-two children (37.4%) had MSK EIM. Among the 52 patients with CD-MSK EIM, 7 had sarcopenia (13.5%) (Table 1). No statistically significant difference was found in the prevalence of sarcopenia in patients with MSK EIM compared to CD-alone (17.2%) (p=0.555). Only 15.8% (22/139) of the total cohort and 40% (21/52) of the MSK EIM group had seen a rheumatologist. Table 1. Associations between clinical characteristics of pediatric patients with Crohn’s Disease and sarcopenia. Conclusion Initial findings from our study demonstrate that 13.5% of children with CD who have MSK EIM have sarcopenia. At baseline, patients with CD-related sarcopenia did demonstrate higher bowel disease activity, increased admissions to hospital and more systemic inflammation (higher ESR, lower Hb). Limitations of this study include the lack of systematic rheumatology assessment of CD patients for MSK EIM, resulting in potential under-reporting of MSK EIM. Further analyses are planned to evaluate the impact of sarcopenia on bowel disease outcomes over time in both groups. [1.] Atlan G. J Pediatr Gastroenterol Nutr 2021;72:883-8. [2.] Lurz E. J Cachexia Sarcopenia Muscle 2020;11:1055-65.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".