Background/Purpose: Gastrointestinal tract involvement in systemic sclerosis (SSc) occurs in almost all patients varying in severity and affecting motility, digestion, absorption and excretion. These abnormalities can cause malnutrition and significant changes in body composition, perhaps the most important is the progressive and gradual loss of the mass, function and strength of the skeletal muscle known as sarcopenia, which increases the risk of physical disability, worsening of the quality of life and risk of falls.

Methods: An observational, prospective, cross-sectional study was conducted in adult patients who met the ACR/EULAR 2013 classification criteria, evaluated by the rheumatology outpatient service of the British Hospital of Buenos Aires. Body composition was assessed by dual energy X-ray absorptiometry (DXA), grip strength using a Jamar dynamometer following the standardized Mathiowetz standards and performance by 4-meter gait speed. According to European Working Group on Sarcopenia in Older People (EWGSOP),  skeletal muscle mass index (SMMI) was calculated as the sum of arms and legs fat and bone-free mass, in kilogram, and height squared meter. The cutoff values for sarcopenia were ≤5.5 kg/m2 in women and ≤7.26 kg/m2 in men, grip strength for women < 20 kg and men < 30 kg and for walking speed < 0.8 m/s in both genders.

Results: A total of 27 patients were included, 20 (74%) were females. The mean inclusion age was 52.5 (± 14.1) years and mean diagnosis age was 44.6 (± 12.8) years, with a mean time of disease evolution of 93.62 (± 83.68) months. LcSSc were reported in 16 (59.2%) patients. We found a mean Rodnan score of 7.2 (± 6.8), Medsger score of 2.3 (± 1.2), EUSTAR activity score of 0.5 (± 0.2), SHAQ of 1.2 (± 0.4) and EVA of 17 (± 14.5). The mean weight was 68.8 (± 12.5) kg, size 162.5 (± 7.9) cm and BMI was 26.1 (± 4.5) kg/m2. Mean lean appendicular mass was 17.92 (± 4.3) kg with an SMMI of 6.74 (± 1.16) kg/m2, grip strength in dominant hand of 22.8 (± 7.9) kg and non-dominant hand of 21.4 (± 9) kg, speed of 0.65 (± 0.57) m/s. Sarcopenia was found in 9 (33.3%) patients (lcSSc in 6/16 (37.5%) and dcSSc in 3/11 (27.2%) patients), among whom was found presarcopenia in 4 (14.81%) patients, mild sarcopenia in 4 (14.81%) patients and severe sarcopenia in 1 (3.7%) patient, with an average of physical activity of 2094 (± 2063) METS and risk of malnutrition with a median of 0.58 (range: 0-4).

Conclusion: Sarcopenia frequency was found in 33.3% of patients. The recognition of this condition has important therapeutic implications, due to the impact on the quality of life, morbidity and mortality. Strategies should include a focus on the nutritional aspects, improving the protein-rich diet intake with physical training program that aims to increase muscle mass and improve strength and performance, maintaining an adequate control of the disease and associated comorbidities.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/sarcopenia-in-systemic-sclerosis/