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Prevalence of Sarcopenia and its Association with Antirheumatic Drugs in Middle-Aged and Older Adults with Rheumatoid Arthritis: A Systematic Review and Meta-analysis

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Abstract

To examine the prevalence of sarcopenia and its association with antirheumatic drugs in adults with rheumatoid arthritis (RA). This review was registered on PROSPERO and followed PRISMA guidelines. Electronic databases were searched for studies reporting on the prevalence of sarcopenia in adults with RA using any muscle index (muscle mass, strength and/or physical performance) and cutpoints as recommended by established criteria (EWGSOP1/2, AWGS, FNIH, SDOC). The secondary objective was to investigate the relationship between RA, antirheumatic drugs, and sarcopenia. Among 2240 middle-aged and older adults with RA (mean age: 47.7 ± 5.5 to 75.0 ± 6.2 years, 83.8% women), the pooled prevalence of low muscle mass/sarcopenia was 30.2% [95% confidence interval (CI) 24.2–36.2%; 16 studies; I2: 89.2%]. Sub-group analysis showed a non-significant higher prevalence of low muscle mass alone (32.6%, 95% CI 25.0–40.3%; I2: 87.9%) versus consensus definitions of sarcopenia (25.4%, 95% CI 15.4–35.3%; I2: 91.2%, p = 0.255). In adults with RA, corticosteroid use was positively associated with sarcopenia [odds ratio (OR) 1.46, 95% CI 0.94–2.29, 7 studies; I2: 47.5%] while conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was inversely associated (OR 0.70, 95% CI 0.52–0.94; 6 studies: I2: 0.00%) with this muscle disease. No association was found for biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) (OR 0.83, 95% CI 0.54–1.30; 6 studies: I2: 47.6%). Sarcopenia is a common comorbidity of RA, and as such, clinicians should screen for this muscle disease in adults with RA. Further longitudinal studies are needed to understand the role of antirheumatic drugs (particularly type, dosing, and duration) in the development of sarcopenia.

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Acknowledgements

The authors would like to thank Evelyn Hutcheon (Clinical Services Librarian, Western Health Library Service, Western Health, Victoria, Australia), who assisted greatly with the construction of the search strategy.

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No specific funding was received from any bodies in the public, commercial, or not-for-profit sectors to carry out the work described in this article.

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  1. Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia

    Thang Dao, Ben Kirk, Sara Vogrin & Gustavo Duque

  2. Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, 176 Furlong Road, St. Albans, VIC, 3121, Australia

    Thang Dao, Ben Kirk, Steven Phu, Sara Vogrin & Gustavo Duque

  3. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia

    Steven Phu

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Dao, T., Kirk, B., Phu, S. et al. Prevalence of Sarcopenia and its Association with Antirheumatic Drugs in Middle-Aged and Older Adults with Rheumatoid Arthritis: A Systematic Review and Meta-analysis. Calcif Tissue Int 109, 475–489 (2021). https://doi.org/10.1007/s00223-021-00873-w

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