Cachexia in rheumatoid arthritis

Rheumatoid cachexia refers to the loss of muscle mass and strength due to rheumatoid arthritis (RA). It’s often called muscle wasting.

About two thirds of people with RA experience this complication if they don’t control their RA.

Muscle wasting adds to the tired, achy feeling that people with RA experience. It can also cause serious complications like heart disease. People with RA who have muscle wasting may have a shorter life expectancy.

Read on to see how cachexia is identified, understand what causes it, and learn what you can do to keep yourself healthy.

People who experience 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.

People with muscle wasting have less hand and thigh strength and may have difficulty performing simple tasks. Even though muscle wasting means loss of tissue, people with this condition 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. People with RA often exercise less over time because of the discomfort of RA, and that can make them gain weight.

Alternately, people may become depressed, eat less, and lose weight. It’s important to note that not all people with cachexia will undergo weight loss. People with cachexia may even gain fat, leading to an overall increase in weight.

The exact causes of muscle wasting are hard to identify. There seems to be a connection with having too much of a protein (cytokine) produced by immune system cells.

Obesity also may play a role, especially when the person’s diet is high in saturated fat. A lack of resistance exercise is also related to muscle wasting.

People with RA may not want to exercise because of the pain and difficulty in moving their joints. This lack of activity can lead to muscle wasting.

While there are no known cures for muscle wasting, you can do a lot to halt deterioration and build back muscle. Resistance exercise can prevent lean muscle loss, increase range of motion, and reduce the pain of RA.

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.


If you have RA, you can still improve your condition and fight muscle wasting with exercise. Resistance training is considered a good choice for people with RA.

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 effect on your joints.

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


While some people with RA and muscle wasting may be malnourished, merely eating more is not the answer. This is because the affected muscles don’t absorb nutrition properly.

In fact, many people with RA have obesity and cachexia simultaneously. Studies have shown that adding fish oil to your diet can improve weight and muscle strength, and reduce fatigue.

Ask your doctor for specific dietary guidelines. They will most likely recommend a high-protein, low-carbohydrate anti-inflammatory diet.

Medical help

There are no reliable tests to determine if someone has cachexia, but measuring body mass index and assessing levels of malnutrition can provide helpful indicators. Internal imaging tests like MRI scans and CT scans also help doctors identify muscle wasting.

Medications that tend to help treat rheumatoid cachexia are the same drugs used to treat RA. Medications that treat RA and may also improve muscle mass include:

Cachexia is a serious complication for people with RA. Lean muscle mass loss leads to pain, fatigue, depression, accidents caused by poor balance, and even heart failure.

Exercise can not only halt or reverse muscle wasting, but also treat other aspects of the disease. Talk to your doctor about a healthy exercise routine to supplement the recommended RA medications. Also, be sure to ask about the latest medical treatments and dietary news.