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Rheumatology Advance Access originally published online on April 30, 2008
Rheumatology 2008 47(8):1124-1131; doi:10.1093/rheumatology/ken146
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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Rheumatoid cachexia: a clinical perspective

G. D. Summers1, C. M. Deighton1, M. J. Rennie2 and A. H. Booth1

1Department of Rheumatology, Derby Hospitals NHS Foundation Trust and 2University of Nottingham, Graduate Entry Medical School, Derby City Hospital, Derby, UK.

Correspondence to: G. D. Summers, Department of Rheumatology, Derby Hospitals NHS Foundation Trust, Derbyshire Royal Infirmary, London Road, Derby DE1 2QY, UK. E-mail: greg.summers{at}derbyhospitals.nhs.uk


  Abstract

Rheumatoid cachexia is under-recognized in clinical practice. The loss of lean body tissue, which characterizes cachexia, is often compensated for by gain in body fat—so called ‘cachectic obesity’—so that 85% or more RA patients have a normal BMI. Severe cachexia with loss of weight leads to increased morbidity and premature mortality but loss of muscle bulk with a normal BMI also associates with poor clinical outcomes. Increasing BMI, even into the obese range, is associated with less joint damage and reduced mortality. Measurement of body composition using DXA and other techniques is feasible but the results must be interpreted with care. Newer techniques such as whole-body MRI will help define with more confidence the mass and distribution of fat and muscle and help elucidate the relationships between body composition and outcomes. Cachexia shows little response to diet alone but progressive resistance training and anti-TNF therapies show promise in tackling this potentially disabling extra-articular feature of RA.

KEY WORDS: Rheumatoid arthritis, Rheumatoid cachexia, Body composition measurement, Body mass index

Submitted 30 November 2007; revised version accepted 18 March 2008.
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