Background/Purpose: Systemic sclerosis (SSc) is a chronic autoimmune disease with a heterogeneous clinical expression that heavily affects the functionality and quality of life of patients. Sarcopenia is an insidious complication of SSc, often poorly recognized and underdiagnosed, but difficult to manage and with important prognostic repercussions. The aim of this study was to evaluate the prevalence of sarcopenia in subjects with SSc, trying to obtain a characterization as complete as possible through a multidisciplinary approach.

Methods: Consecutive adult SSc patients were evaluated by a multidisciplinary team of rheumatologists, nutritionists and physiotherapists to identify the presence of sarcopenia according to the diagnostic algorithm proposed by the EWGSOP2 consensus in 2019. After completing the SARC-F questionnaire, generally used for the case finding, the patients’ muscle strength was measured with the hand grip test and the 5-times sit to stand test (5STS). Subsequently, the confirmation of a possible sarcopenia was obtained by measuring the appendicular skeletal muscle mass (ASSM) by bioimpedance vector analysis (BIVA), a method also used to identify subjects with a state of malnutrition. Finally, the severity of sarcopenia was assessed using the following physical performance tests: short performance physical battery (SPPB – composite score of balance tests, 4m linear walk and 5STS), time up and go (TUG – static balance and dynamic) and gait speed.

Results: Thirty-three SSc patients (87.8% female, mean age 61.2 ± 12 years) were evaluated. The SARC-F questionnaire resulted pathological in 9 of them, whereas for the evaluation of muscle strength pathological values were observed in 42.4% and in 45.4% of the hand grip and 5STS tests, respectively. The ASSM/height ratio was used for the evaluation of muscle mass and was found pathologically reduced in 37.2% of patients. Finally, physical performance tests had pathological results in 27.2% of SPPB, 9% of TUG and 15.1% of gait speed tests. According to the definitions proposed by the EWGSOP2, in our cohort sarcopenia was found in 13 (39.4%) SSc patients, of which 5 (15.1%) presented a severe form. In addition, BIVA found malnutrition in 12 patients and this happened in combination with a sarcopenic state in 75% of cases. Malnourished subjects had significantly lower hand grip strength values (p=0.007), worse SPPB scores (p=0.03), and longer TUG times (p=0.05).

Conclusion: Sarcopenia emerges as a relatively frequent complication in SSc, with important repercussions on the physical-dynamic sphere and a profound interrelationship with nutritional status. A multidisciplinary approach is essential for an accurate diagnosis of sarcopenia in potentially high-risk individuals such as those with SSc.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/multidisciplinary-and-multiparametric-evaluation-of-sarcopenia-in-patients-with-systemic-sclerosis/