AB0681 The 2-year impact of COVID-19 pandemic on muscle strength and physical performance in patients with systemic sclerosis: a cohort study

Abstract

BackgroundSystemic sclerosis (SSc) patients are particularly prone to developing loss of muscle strength and worsening of physical performance due to decreased physical activity1. The lifestyle changes imposed by the SARS-CoV-2 outbreak have increased the incidence of sarcopenia in at-risk individuals2. However, the literature is scarce on the impacts of the COVID-19 pandemic on muscle strength and physical performance of SSc patients.Objectives(1) To assess the impact of the COVID-19 pandemic on muscle strength and physical performance of SSc patients and (2) to verify the associations of muscle strength and physical performance with inflammatory markers in a cohort study.MethodsSSc patients who met the ACR / EULAR 2013 classification criteria were included. Patients followed between 2019 and 2021. Muscle strength was measured by handgrip strength (kg) and sit and stand (SST, seconds) tests. Physical performance was measured by timed up and go (TUG, seconds) and short physical performance battery (SPPB, points). Inflammatory markers were measured by C-reactive protein (CRP). T test for independent samples, Mann-Whitney U test of independent samples and Spearman’s correlation coefficients were explored. The significance level was set at p ≤ 0.05 for all analyses.ResultsForty SSc patients concluded this study. At baseline, the mean age was 59 ±11.1 years old and the median disease duration was 13.1 (6.4-19.2) years. Patients had a median of 4.5 clinic visits (3.0-6.0) over the 2 years. The majority of patients were women (37, 92.5%). Ten patients (25%) had diffuse cutaneous disease, 30 patients (75%) non-diffuse cutaneous disease [25 patients (62.5%) had limited cutaneous disease, and 5 (12.5%) had sine scleroderma SSc]. The median of CRP was 2.9 (1.2-5.3). The median of handgrip strength was 20.0 (10.3-25.8) kg to the right hand and 19.0 (12.0-22.8) kg to the left hand. The median of SST was 14.4 (11.9-18.7) seconds. The median of TUG was 8.6 (7.7-9.5) seconds and the median of SPPB was 9.8 (9.0-11.0) points. The CRP was positively associated with SST (r=0.3, p=0.047) and TUG (r=0.3, p=0.029), and negatively with SPPB (r=-0.4, p=0.016). After 2 years of follow-up, the patients showed improvement in the left handgrip strength test (p=0.049) and SST (p=0.001). In physical performance, they showed improvement in the TUG test (p=0.005) and SPPB (p=0.001). The CRP was associated positively with TUG (r=0.4, p=0.033), no other associations were found.ConclusionDespite the COVID-19 pandemic and the restrictions imposed, in this population of patients with SSc, we did not detect any worsening in muscle strength and physical performance. Some of these parameters of muscle strength and physical performance were associated with the inflammatory marker CRP. More investigations are needed to assess the actual impact and possible associations.Table 1.Baseline comparison and after 2 years of patients with SScBaselineAfter 2 yearspCRP (mg/L),median (IQR)2.9 (1.2-5.3)2.3 (1.0-5.1)0.361Handgrip (kg),right, median (IQR)20.0 (10.3-25.8)20.5 (14.3-27.0)0.072left, median (IQR)19.0 (12.0-22.8)19.0 (14.0-26.0)0.049*SST (seconds),median (IQR)14.4 (11.9-18.7)11.6 (9.9-13.1)0.001*TUG (seconds),median (IQR)8.6 (7.7-9.5)7.9 (7.1-9.2)0.005*SPPB (points),median (IQR)9.8 (9.0-11.0)11.0 (10.0-12.0)0.001*SSc: systemic sclerosis; IQR: interquartile range; mg: milligram; L: liter; kg: kilograms grams; TUG: timed and up go; SST: sit and stand test; SPPB: short physical performance battery; PCR: C-reactive protein; and * significant difference of ≤0.05.