Rheumatoid Arthritis

Rheumatoid Cachexia: Symptoms, Causes, and Treatment

  • Cachexia in Rheumatoid Arthritis

    Rheumatoid cachexia refers to the loss of mass and strength in the muscles due to rheumatoid arthritis (RA). It’s often called “muscle wasting.” About two thirds of patients with RA suffer from this complication. Muscle wasting adds to the tired, achy feeling that RA patients experience. It can also cause serious complications like heart disease. RA patients with muscle wasting almost always have shorter life expectancy. This slideshow will help you identify cachexia, understand what causes it, and show what you can do to keep yourself healthy.    

  • Symptoms of Muscle Wasting

    Patients who suffer from cachexia have a feeling of tired, overworked muscles. This is partly because muscle wasting in RA causes “elevated resting energy expenditure,” meaning your muscles are using energy even when you’re keeping still. Patients with muscle wasting have less hand and thigh strength and may experience difficulty performing simple tasks. Even though muscle wasting means loss of tissue, patients may not lose weight because cachexia means only the loss of lean tissue, not fat.

  • Weight Changes and Muscle Wasting

    There are many reasons a person with RA may have changes in their weight. RA patients often exercise less over time because of the discomfort of RA, and that can make them gain weight. Alternately, patients may become depressed, eat less, and lose weight. It’s important to note that not all people suffering from cachexia will undergo weight loss. Cachexia patients may even gain fat, leading to an overall increase in weight.

  • Causes

    Exact causes of muscle wasting are hard to identify. There seems to be a relationship with having too much of the protein cytokine. Obesity also may play a role, especially when the patient’s diet is high in saturated fat.  A lack of resistance exercise is also related to muscle wasting. RA patients may not want to exercise because of the pain and difficulty in moving their joints. This lack of activity can lead to muscle wasting.

  • Important Points

    The following are some important points to consider regarding rheumatoid cachexia:

    • Because the heart is a muscle, muscle wasting and heart failure are commonly associated
    • Even when RA is treated successfully, and joint inflammation is under control, muscle wasting can continue if it goes untreated.
    • The right kind of exercise can slow or reverse muscle wasting.

  • Treatments

    While there are no known cures for muscle wasting, there is a lot you can do to halt deterioration and build back muscle. Resistance exercise fights lean muscle loss, can increase range of motion, and can reduce the pain of rheumatoid arthritis. One study indicates that more than one medical approach is necessary to fight lean tissue loss. Dietary approaches have also been shown to be effective in certain cases.

  • Exercise

    Even if you have RA, you can improve your condition and fight muscle wasting with exercise. Resistance training is considered a good choice for RA patients. In resistance training, you push or pull to increase the strength of your muscles. You can do this kind of exercise in water to reduce the impact on joints.

    Resistance training builds lean muscle mass and increases your range of motion, allowing you to move more easily. Resistance training has also been shown to decrease arthritis pain, help patients lose weight, and reduce the incidence of falling.

  • Medical Help

    There are no reliable tests to determine if a patient is suffering from cachexia, but body mass index (BMI) and assessing the patient’s levels of malnutrition can provide helpful indicators. Internal imaging tests like magnetic resonance imaging (MRI) and computed tomography (CT) scans also help doctors identify muscle wasting. Treatments that show promise include TNF blockade and anti-cytokine therapy.

  • Diet

    While RA patients with muscle wasting usually have malnutrition, merely eating more is not the answer, since the problem is that the affected muscles don’t absorb nutrition properly. In fact, many RA patients suffer from obesity and cachexia simultaneously. Studies have shown that adding fish oil to the diet improved patients’ weight and muscle strength, and reduced fatigue. Ask your doctor for specific dietary guidelines. They will most likely recommend a high-protein, low-carbohydrate diet.

  • Feeling Better

    Cachexia is a serious complication for rheumatoid arthritis patients. Lean muscle loss leads to pain, fatigue, depression, accidents caused by poor balance, and even heart failure. Luckily, exercise can not only halt or reverse muscle wasting, it can also treat other aspects of your disease. Talk to your doctor about a healthy exercise routine, and be sure to ask about the latest medical treatments and dietary news.

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References:

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  • Anti-TNF. (2012, June). American College of Rheumatology. Retrieved December 1, 2013, from http://www.rheumatology.org/Practice/Clinical/Patients/Medications/Anti-TNF/
  • Elkan, A., Engvall, I., Cederholm, T., & Hafström, I. (2009). Rheumatoid cachexia, central obesity and malnutrition in patients with low-active rheumatoid arthritis: feasibility of anthropometry, Mini Nutritional Assessment and body composition techniques. The Journal of Rheumatology, 8(4), 315-22.
  • Fülster, S., Tacke, M., Sandek, A., Ebner, N., Tschöpe, C., Doehner, W., et al. (2013). Muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure (SICA-HF). European Heart Journal, 34(7), 509-12.
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  • Why strength training? (2011, February 24). Centers for Disease Control and Prevention. Retrieved December 1, 2013, from http://www.cdc.gov/physicalactivity/growingstronger/why/
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