Time to Deal with Rheumatoid Cachexia: Prevalence, Diagnostic Criteria, Treatment Effects and Evidence for Management

Abstract

Cachexia is an early result of rheumatoid arthritis (RA) (rheumatoid cachexia, RC), characterised mainly by involuntary loss of fat-free mass. RC is apparent in 1–67% of patients with RA, depending on the diagnostic criteria applied and the method used for the assessment of body composition. RC is associated with increased inflammation and disability, lower health perception, and greater mortality risk. These changes in body composition are driven by the inflammation process, the low levels of physical activity, the underlying testosterone deficiency and hypogonadism, and the pharmacotherapy required for RA. Chronic inflammation enhances resting energy expenditure as a response to stress, inducing an energy deficit, further propelling protein turnover. The use of corticosteroids and tumour necrosis factor α (TNF-α) inhibitors tend to increase fat accumulation, whereas other disease-modifying antirheumatic drugs (DMARDs) appear to induce increments in fat-free mass. The present review presents all information regarding the prevalence of RC, diagnostic criteria, and comorbidities, as well as the effects of pharmacotherapy and medical nutrition therapy on body composition of patients with RA.

Mechanistic Evaluation of Antiarthritic Effects of Eupatilin in CFA-Induced Arthritic Rats: An in Vivo and in Silico Study

“…29,30 Numerous factors contribute to the development of this RA-related muscle wasting, but it is well-recognized that high TNF-α levels can result in cachexia. [31][32][33] Tumor necrosis factor-α stimulates energy consumption by altering the metabolism of proteins and lipids. This causes a decrease in calorie intake by inducing anorexia, which ends up in cachexia.…”

Fly Me to the Immune: Immunonutrition in Rheumatic Diseases

“…Patients with RDs often experience a variety of nutrition-related issues, including malnutrition, 8 rheumatoid cachexia, 9 , 10 overweight and obesity, 8 , 11 , 12 gut dysbiosis, 13 – 16 nutritional deficiencies 11 , 17 – 20 and many more. Moreover, the pathophysiology of RDs induces important changes in the nutritional status of the affected populations, including hypermetabolism and increased oxidative stress.…”

Energy Regulation in Inflammatory Sarcopenia by the Purinergic System

“…Rheumatoid arthritis (RA) is the most common autoimmune disease, with 1% of the world population affected [74]. Apart from articular manifestations, RA has several systemic comorbidities, including rheumatoid cachexia (RC), a condition that impacts function and quality of life and affects approximately 11% to 26% of RA patients worldwide [51,75]. It is characterized by a reduced skeletal muscle mass with either stable or increased fat mass, degradation of balance and disruption of muscle protein synthesis, decreased muscle mass, strength, and function, together with total energy expenditure, insulin resistance, increased basal metabolic rate, and inflammation [51].…”

“…Methotrexate (MTX) monotherapy is a first line DMARD agent for RA. It is unknown whether MTX monotherapy is beneficial for RC, but some authors have demonstrated that MTX in combination with different drugs may protect against the development of RC [75]. The use of Janus kinase (JAK) inhibitors has also been explored.…”