Prevalence of sarcopenia in patients with rheumatoid arthritis: a cross-sectional study

Sarcopenia, defined by reductions in muscle mass and strength, increases the risk of adverse outcomes in patients with rheumatoid arthritis (RA)-driven in part by chronic inflammation-and is linked to a poor prognosis. This study aimed to investigate the prevalence of sarcopenia in patients with RA using Asian Working Group for Sarcopenia (AWGS) 2025 criteria and to analyse its associated clinical features.

This cross-sectional study enrolled 978 patients with RA (mean age 60.1±12.1 years, range 21-99 years and 86.4% female) diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism (EULAR) classification criteria. Sarcopenia was diagnosed based on the AWGS 2025 consensus, using bioelectrical impedance analysis for appendicular skeletal muscle mass index, handgrip dynamometry for muscle strength. Demographic data, clinical parameters and medication use were collected. Statistical analysis was performed using SPSS V.21.0.

The overall prevalence of sarcopenia among patients with RA was 18.6% (182/978). Male gender (OR 9.140, 95% CI 5.211 to 16.029), body mass index (BMI) (OR 0.586, 95% CI 0.534 to 0.643), disease duration (OR 1.046, 95% CI 1.025 to 1.069), rheumatoid factor (RF)-IgM level (OR 1.002, 95% CI 1.000 to 1.003), prednisone dosage (OR 1.094, 95% CI 1.033 to 1.159), tumour necrosis factor inhibitors (TNF-i) use (OR 0.502, 95% CI 0.312 to 0.808) and tocilizumab use (OR 0.493, 95% CI 0.304 to 0.799) were associated with sarcopenia in patients with RA.

The prevalence of sarcopenia is considerable in patients with RA. Key risk factors include male gender, lower BMI, longer disease duration, higher RF-IgM level and higher dosage of glucocorticoid use. The use of tocilizumab and TNF-i may be associated with a reduced incidence of sarcopenia in this population.