If you or a loved one is unlucky enough to have rheumatoid arthritis, you are probably familiar with the constellation of unpleasant symptoms that can accompany the disease, such as fatigue, weakness, chronic pain, joint pain and deformation, loss of stamina and inability to concentrate. You may be less familiar with rheumatoid cachexia, a medical term that denotes extreme muscle wasting, frailty and loss of strength.
Simply put, “cachexia is a loss of lean muscle mass along with an increase in fat tissue,” says Kimberly Steinbarger, the academic coordinator of clinical education at the School of Physical Therapy at Husson University in Bangor, Maine.
“[Cachexia] can be sneaky, because while muscle tissue is wasting away, fat tissue is increasing, keeping the patient at the same overall weight.”
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So, although the patient may appear robust on the surface, underlying muscle tissue loss can be eroding strength and stamina, resulting in RA-related frailty.
“[This] frailty puts them at higher risk for functional decline and cardiovascular disease,” Steinbarger says. “It occurs in as many as 60 percent of all people with RA and takes place even when the muscles are completely at rest. And although rheumatoid cachexia causes muscle loss, it does not result in a similar loss of fat,” she says.
According to Seattle rheumatologist Dr. James S. Andrews, frailty in adults with RA is determined based on five factors: body mass index of 18.5 or lower; low grip strength (adjusted for gender and BMI, measured by a handheld dynamometer); severe fatigue (measured by the Multidimensional Assessment of Fatigue); slow walking speed (adjusted for gender and height); and low physical activity (measured by the International Physical Activity Questionnaire). “Adults with three or more of these established deficits are considered to be frail,” says Andrews, who is acting instructor in the Division of Rheumatology at the University of Washington School of Medicine.
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Rheumatoid cachexia can have serious consequences. Although it predominantly causes loss of skeletal muscle, it can also cause wasting in the viscera, including the heart, and in the immune system, and it is believed to accelerate potential complications and the possibility of a premature death for those with RA. Rheumatoid cachexia is poorly understood, but it is accompanied by increased energy expenditure of the muscles even when they’re at rest, and by the production of proteins that promote inflammation throughout the body.
To date, there is no standard treatment for the muscle wasting caused by rheumatoid cachexia. However, physical exercise is currently believed to be the most important and clinically relevant countermeasure one can take to slow the process. In general, a combination of skeletal muscle strength training and aerobic exercise is recommended, but any exercise program must be prescribed with the patient’s disease status, overall health and safety in mind.
Computed tomography scans and magnetic resonance imaging scans can help provide a clear understanding of the state of muscle wasting and help your rheumatologist determine which exercise programs may provide you the greatest benefit.
Resistance training exercise using light weights or elastic bands can potentially counter the loss of lean tissue that occurs with rheumatoid cachexia, and it may also help alleviate some of RA’s chronic pain, while expanding one’s range of motion. Many people prefer to perform resistance training in water because it puts less stress on already fragile joints.
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Dietary modification may also help prevent muscle loss. Your doctor or nutritionist may work with you to design a high-protein, low-carbohydrate diet, and people with rheumatoid arthritis should avoid high-calorie diets. Fish oil and other substances may help reduce fatigue, improve weight and muscle strength — and possibly even offer side benefits like fighting inflammation.
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60 Percent of People With Rheumatoid Arthritis May Suffer From Frailty originally appeared on usnews.com
