Patients with rheumatoid arthritis (RA) live with joint pain, inflammation, stiffness, swelling, and fatigue — but muscle problems are also a part of life with RA.

Many patients with rheumatic illnesses live with a muscle wasting condition called rheumatoid cachexia. According to the National Institutes of Health, rheumatoid cachexia is “involuntary loss of body cell mass, which predominates in skeletal muscle.”

Even with otherwise successful treatments and therapies, studies have shown that the body composition of RA patients remains altered.

Rheumatoid cachexia

Patients showed a decrease in lean muscle mass and an increase in body fat, despite improvements in disease progression and symptom management while using certain medications.

A loss of muscle and an increase in body mass index can make it more difficult for RA patients to achieve remission.

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Muscle Mass Down, Body Fat Up

In a study, presented at the annual meeting of the British Society for Rheumatology, patients with RA had an 11 percent decrease of lean muscle mass in the arms and legs along with a 15 percent increase of body fat, compared to healthy individuals. 

Historically, rheumatoid arthritis has been characterized by changes in body composition such as a loss of muscle mass and excessive fat mass, especially of the trunk.

“This degree and prevalence of rheumatoid cachexia is alarming because, in addition to diminished function and increased disability, muscle loss is associated with impaired immune and pulmonary function, osteoporosis, glucose intolerance, and increased mortality,” wrote study author Andrew B. Lemmey, Ph.D., and his colleagues. 

The changes in body composition are thought to be caused by autoimmune activity leading to inflammation, much like the other symptoms that come with RA.

Certified personal trainer Michael Smith of Philadelphia, Pennsylvania, explains that “Exercise and muscle building is crucial for people living with a musculoskeletal disease. Lifting light weights or doing low-impact exercises like bicycling or swimming can build muscle tone, decrease inflammation, and take stress off the joints, as well as improving overall health.” 

Muscle strength training and aerobic exercise are often suggested in moderation for patients with rheumatoid arthritis, but any exercise activity or physical therapy needs to be prescribed with the RA patient’s unique status in mind. 

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Ailment Can Afflict Anyone with RA

Rheumatoid cachexia is not an issue that only patients with severe RA face. In fact, The Journal of Rheumatology estimates that nearly two-thirds of all RA patients live with muscle wasting associated with the disease.

“These results suggest that the perturbations in body composition occur very early in rheumatoid arthritis, probably prior to diagnosis and initiation of treatment, and that to restore physical function, interventions that improve body composition (e.g., exercise) are required,” concluded Lemmey and his colleagues. 

Lara Collins, of Palmetto, Florida, has had RA for 10 years.

“I truly believe that physical activity is the best medicine for my RA,” she said. “I hope that gaining more strength will decrease pain and disability for me. I’m learning that my muscles need to be strong and healthy, not just my joints.”

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