Is sarcopenia a real concern in ankylosing spondylitis? A systematic literature review

Explore the association between sarcopenia and spondyloarthritis (SpA), particularly ankylosing spondylitis (AS), with a focus on muscle mass, strength, and axial SpA. The occurrence of pre-sarcopenia or probable sarcopenia was more prevalent than sarcopenia, particularly marked by a significant reduction in muscle strength. The association of pre-sarcopenia with elevated AS disease activity suggests a potential influence of chronic inflammation on muscle health. Evidence points to a correlation between AS and premature muscle strength loss, suggesting a potential onset of sarcopenia, underscoring the importance of early intervention strategies for successful aging in individuals with AS. Sarcopenia is a condition defined as loss of muscle mass and strength, associated with poor functional performance and disability. Sarcopenia can be exacerbated or worsened in presence of inflammation, sedentary lifestyle and cytokine imbalance, thus it frequently occurs in people affected by rheumatic diseases. This systematic literature review aims to explore the association between sarcopenia and spondyloarthritis (SpA) and its most frequent manifestation, i.e. ankylosing spondylitis (AS). The Scopus, PubMed, and Web of Science databases were searched for articles on muscle mass, muscle strength and axial SpA, from any date to November 2023. Only studies written in English were considered. The methodological quality of the studies included in the review was evaluated using the Newcastle–Ottawa Scales for observational studies and for case–control studies. 190 papers were retrieved from the searches, 14 of which met the inclusion criteria. Rather than diagnosis of sarcopenia, pre-sarcopenia or probable sarcopenia were frequent in people with AS, with a great reduction especially of muscle strength. The pre-sarcopenia status appears to be related to high AS disease activity, suggesting that chronic inflammation resulting in pain, less movement and decreased physical activity could play a role in the muscle heath of AS patients. Our review confirms the existence of an association between AS and loss of muscle strength—likely sarcopenia—already at a young age. Preventive and early strategies should be adopted to ensure successful aging for individuals with AS.