Muscle wasting in male TNF-α blocker naïve ankylosing spondylitis patients: a comparison of gender differences in body composition

Rheumatology (Oxford). 2017 Sep 1;56(9):1566-1572. doi: 10.1093/rheumatology/kex187.


Objective: To assess gender differences in body composition (BC) in a cohort of AS patients naïve to TNF-α blockers.

Methods: Patients included fulfilled the Modified New York criteria for AS. Demographic information and disease activity measures (ASDAS and BASDAI) were reported. BC was measured by whole body DXA. Body fat percentage (BF%), fat mass index (FMI), fat free mass index (FFMI) and android/gynoid fat ratio were reported and compared between men and women and with the reference population (percentiles).

Results: Seventy consecutive patients were included; 60% were men. Demographic variables were similar, except for dyslipidaemia (57.1% of men; 14.3% of women). Women had significantly more fat (BF%, FMI), and less muscle (FFMI) than men, but below the median of the reference population. Male AS patients had a markedly low FFMI (31.7th percentile) compared with the reference population. In the whole group, after multivariate analysis, an ASDAS CRP >3.5 was related to lower fat free mass content. In men, a significant relationship between having a high disease activity (ASDAS, BASDAI) and lower BF% or FMI percentile was found, but in women it was the opposite.

Conclusion: Muscle wasting, measured as low FFMI compared with the reference population, was found in male TNF-α blocker naïve AS patients, especially in those with active disease. Women had higher volumes of body fat than men, but near the median of the reference population. The relationships between fat content and disease activity support the complex association between adipose tissue and inflammation.

Keywords: ankylosing spondylitis; body composition; dual-energy X-ray absorptiometry; muscle wasting.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon / methods
  • Adipose Tissue / pathology
  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antirheumatic Agents / therapeutic use
  • Body Composition / physiology*
  • Dyslipidemias / etiology
  • Female
  • Humans
  • Hypertension / etiology
  • Male
  • Middle Aged
  • Muscular Atrophy / etiology*
  • Muscular Atrophy / pathology
  • Muscular Atrophy / physiopathology
  • Prospective Studies
  • Severity of Illness Index
  • Sex Characteristics*
  • Spondylitis, Ankylosing / complications*
  • Spondylitis, Ankylosing / drug therapy
  • Spondylitis, Ankylosing / pathology
  • Spondylitis, Ankylosing / physiopathology
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors


  • Anti-Inflammatory Agents, Non-Steroidal
  • Antirheumatic Agents
  • TNF protein, human
  • Tumor Necrosis Factor-alpha