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Published on: March 21, 2021
Multiparametric assessment of sarcopenia in systemic sclerosis: prognostic implications and interplay with
Marco Di Battista1, Alessandra Rossi2, Gaia Pisano2
1Rheumatology Unit, University of Pisa, Italy. dibattista.marco91@gmail.com.
Objectives:
Sarcopenia, defined by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) as loss of muscle strength, mass and function, is an underestimated complication in systemic sclerosis (SSc). We aimed to assess sarcopenia prevalence in SSc, identify clinical correlations, and evaluate its prognostic impact.
Methods:
Consecutive adult SSc patients underwent multidisciplinary same-day assessment (rheumatologists, physiotherapists, nutritionists) and HAQ administration. Sarcopenia was diagnosed using the EWGSOP2 algorithm: SARC-F questionnaire and/or clinical suspicion for screening, muscle strength testing for probable sarcopenia, confirmation with reduced appendicular skeletal muscle mass (by bioelectrical impedance vector analysis [BIVA]), and severity by impaired physical performance. Malnutrition was assessed by BIVA. Mortality was recorded after ≥12 months follow-up.
Results:
Among 204 enrolled patients (86.8% female, mean age 62.3 years), 100 (49%) were at risk of sarcopenia. Of these, 89 (43.6%) had reduced muscle strength (probable sarcopenia), 54 (26.5%) showed low muscle mass (confirmed sarcopenia), and 25 (12.3%) had impaired physical performance (severe cases). Sarcopenic patients were older (p<0.001) and had higher HAQ scores (p<0.001). Malnutrition was identified in 69/204 patients (33.8%) and was more prevalent in sarcopenic patients (72.2% vs. 24.6%, p<0.001). Sarcopenia was strongly associated with malnutrition (OR 5.69, p<0.001). Mortality was significantly higher in sarcopenic patients (16.7% vs. 2.7%, p=0.001), who also showed reduced survival (p<0.001). Sarcopenia predicted mortality (HR 8.99, p=0.001), remaining an independent predictor after adjustment for age (HR 4.09, p=0.04).
Conclusions:
Sarcopenia is frequent in SSc, closely associated with malnutrition, disability and mortality. Sarcopenia is an independent prognostic factor, therefore routine screening and multidisciplinary management are warranted.
