My rheumatologist told me that cachexia is not common anymore. She is right but rheumatoid cachexia which is specific to RA is very common. We are made of water, but we are also made of chemical reactions numbering in the billions. With RA these endless chemical reactions are disrupted.

Do you have rheumatoid cachexia?

Surprisingly up to fifty percent of those with RA do have rheumatoid cachexia. About ten to twenty percent of those with well controlled RA still have rheumatoid cachexia.

You might say that you are overweight so couldn’t have it. However, in rheumatoid cachexia, muscle mass is replaced by fat. The muscle is disappearing and the fat is replacing it. Rheumatoid cachexia and obesity go hand in hand.

Rheumatoid Cachexia  is a condition where RA patients suffer

• an accelerated loss of muscle mass ( increased whole body protein catabolism).
• muscle mass replaced with fat.
• reduced total energy expenditure
• increased resting energy expenditure
• Increased inflammatory cytokine production

Symptoms include

• Decreased muscle mass.
• Changes in muscle fiber.
• Weakness.
• Fat replaces muscle.
• Muscle aches.
• Diet that continues to have adequate protein intake
• Reduced physical activity.
• No energy

Why?

It is thought to be driven by cytokine dysregulation, hypermetabolism and protein degradation. Big words, I know. It means that our protein and our energy metabolism is disrupted by our body’s uncontrolled inflammatory response.

Prognosis

Loss of functional capacity accelerates morbidity and mortality.

Treatment

Getting rheumatoid arthritis under control is important to managing rheumatoid cachexia. Resistance training to build lean muscle mass. High protein, low carbohydrate anti-inflammatory diet. Fish oil. Methotrexate and biologics such as Actemra will help relieve rheumatoid cachexia.