Sarcopenia in Rheumatology Practice: Current Concepts in Diagnosis and Management

Sarcopenia, characterised by progressive loss of skeletal muscle strength, mass and physical performance, is increasingly recognised as an important but under-recognised comorbidity in patients with rheumatic and musculoskeletal diseases (RMDs). Chronic systemic inflammation, physical inactivity, glucocorticoid exposure, nutritional deficiencies and metabolic dysregulation accelerate muscle loss, contributing to frailty, falls, disability, impaired quality of life and increased healthcare utilisation. Although traditionally considered an age-related condition, sarcopenia is now recognised as an important manifestation of chronic inflammatory rheumatic diseases. This narrative review summarises current evidence on the epidemiology, pathophysiology, diagnosis and management of sarcopenia in RMDs, with particular emphasis on its relevance to routine rheumatology practice. Recent consensus recommendations from the European Working Group on Sarcopenia in Older People (EWGSOP2) and the Asian Working Group for Sarcopenia (AWGS 2019) advocate a stepwise diagnostic approach centred on muscle strength, followed by assessment of muscle quantity and physical performance. In this review, practical screening strategies, imaging modalities including dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA) and muscle ultrasound, and disease-specific considerations across major rheumatic diseases are discussed. Current management is based on a multimodal approach combining optimal control of inflammatory disease, progressive resistance exercise, nutritional optimisation, rehabilitation and minimisation of glucocorticoid exposure. Emerging approaches, including circulating biomarkers, artificial intelligence (AI)-based risk prediction and myostatin-targeted therapies, show promise but require further validation before routine clinical implementation. Routine assessment of muscle health should become an integral component of comprehensive rheumatology care to facilitate early diagnosis, individualised management and improved long-term functional outcomes in patients with RMDs.