Introduction:
Rheumatoid arthritis is a condition that causes joint pain, swelling, and stiffness. It's a so-called autoimmune disease. This means that the body's natural self-defense system, the immune system, gets confused and starts attacking the body's healthy tissues. In rheumatoid arthritis, this is primarily due to inflammation in the joints. If a person is having rheumatoid arthritis, their immune system can cause inflammation in one or more joints. Inflammation is usually an important part of how the immune system works. This allows the body to send extra fluid and blood to parts of the body that are being attacked by an infection. Cachexia refers to extreme weight and muscle loss with no effort. It can occur in many other conditions, including cancer, chronic heart failure, chronic renal failure, chronic obstructive pulmonary disease (COPD), AIDS, and rarely RA.
There are three types of cachexia:
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Precachexia - In this about five percent of body weight is lost due to known illness. This category also includes anorexia, metabolic changes, and inflammation.
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Cachexia - Patients lose five percent or more of body weight within 12 months without trying to lose weight. Other symptoms include loss of appetite, fatigue, inflammation, and muscle weakness.
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Refractory Cachexia - This is what happens in the case of cancer, there is weight loss, muscle, function, and no response to cancer treatment. About 80% of terminally ill cancer patients develop cachexia. This type has a high mortality rate.
What Is Rheumatoid Cachexia?
Rheumatoid arthritis (RA) can cause a metabolic condition called rheumatoid cachexia or muscle wasting. This form of cachexia occurs when the body loses muscle mass and retains fat mass. The body develops this condition due to chronic inflammation and lack of physical activity due to RA. Rheumatism cachexia is common in RA patients. Researchers believe that about two-thirds of RA patients may be affected.
What Are the Causes of Rheumatoid Cachexia?
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Determining the exact cause of muscle wasting is difficult. It appears to be related to too many cytokines (proteins involved in inflammation) produced by cells of the immune system.
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Obesity may also play a role, especially if a person's diet is high in saturated fat. Lack of resistance training is also associated with muscle wasting.
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People with rheumatoid arthritis may not want to exercise because of the pain and difficulty of joint movement. This lack of activity can lead to muscle wasting.
What Are the Risk Factors for Rheumatoid Cachexia?
Cachexia most often occurs at the advanced stage of severe conditions. People with any of the following diseases should talk to their doctor about steps to prevent cachexia from developing and how to treat it if it does occur:
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Cancer.
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Chronic obstructive pulmonary disease (COPD).
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Chronic renal failure.
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Congestive heart failure.
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Crohn’s disease (type of inflammatory bowel disease).
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Cystic fibrosis.
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HIV (human immunodeficiency virus).
What Are the Symptoms of Rheumatoid Cachexia?
People with cachexia have a feeling of overworked and tired muscles. This is because the muscle wasting in rheumatoid arthritis causes increased resting energy expenditure. People with muscle wasting may have weak hands and thighs, making it difficult to perform simple tasks. Muscle wasting means tissue loss, whereas cachexia means only lean tissue loss, not fat, so people with this condition may not lose weight.
How Is Rheumatoid Cachexia Diagnosed?
A team of doctors will evaluate body composition to determine whether cachexia is present. Measurement of muscle mass and body fat mass is done. To do this doctors usually use the following methods:
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Bioimpedance Analysis (BIA) - This tool helps measure the body's lean mass. This term primarily refers to the muscle mass of the body. Dual-energy x-ray absorptiometry (DEXA) scan. DEXA allows physicians to determine the body's lean body mass (LBM), which includes organ, skin, bone, and muscle mass.
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Imaging Tests - Testa such as computed tomography (CT) scans and magnetic resonance imaging (MRI) are also available. It also takes basic measurements such as height, weight, and body mass index (BMI).
What Is the Treatment for Rheumatoid Cachexia?
Appropriate RA treatment can help inflammation but tends to be ineffective in rheumatic cachexia. Even if the severity of RA disease decreases and joint inflammation improves, rheumatic cachexia may persist or worsen. Doctors believe that cachexia may increase the risk of death. Early intervention is important to prevent this. There is no standard treatment for rheumatic cachexia. However, experts believe that exercise is the best way to combat this condition. It is important to combine skeletal strength training with cardio. The doctor will create an exercise plan specific to the overall health, medical conditions, and safety concerns. Doctors may also adjust the diet to improve rheumatic cachexia. Physicians suggest a Mediterranean diet along with vitamin D, omega-3s, and antioxidant supplements.
What Are the Complications of Rheumatoid Cachexia?
Fat and muscle wasting in cachexia is severe and may increase morbidity. Cachexia is one of the leading cause of about 1 in 5 deaths in end-stage of severe illnesses. Complications of cachexia include:
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Decreased quality of life and loss of ability to live independently.
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Impaired response to treatment.
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Weakened immunity.
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Exacerbation of underlying chronic disease symptoms.
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Shorter life expectancy due to underlying disease.
How to Prevent Rheumatoid Cachexia?
Even in RA, exercise can prevent and reduce muscle wasting. Resistance training is considered a good option for RA patients. Resistance training involves pushing and pulling to build muscle strength. Doing this type of exercise in water can reduce the impact on the joints. Resistance training increases lean muscle mass and increases range of motion so one can move more easily. It has also been shown to reduce arthritis pain, weight loss, and the incidence of falls.
Conclusion:
Cachexia is a condition that leads to extreme weight loss and muscle wasting. It is a symptom of many chronic diseases such as cancer, chronic renal failure, human immunodeficiency virus (HIV), and multiple sclerosis (disease of brain and spinal cord). It primarily affects people with rheumatoid arthritis. Early detection and exercise are the best ways to prevent and manage it. The condition causes involuntary weight loss, muscle wasting, and often loss of body fat. Loss of skeletal muscle can lead to physical weakness and disability.
