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Rheumatology Advance Access published online on August 3, 2004
Rheumatology, doi:10.1093/rheumatology/keh321
Rheumatology © British Society for Rheumatology 2004; all rights reserved
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Received May 10, 2004
Accepted June 18, 2004

Original Papers

Rheumatoid cachexia: metabolic abnormalities, mechanisms and interventions

L. C. Rall 1* R. Roubenoff 2

1 Marshfield Clinic Research Foundation, Epidemiology Research Center, Marshfield, WI, USA
2 Millennium Pharmaceuticals, Inc., Cambridge, USA; Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA

* To whom correspondence should be addressed. E-mail: rall.laura{at}mcrf.mfldclin.edu.


  Abstract

We have previously identified the phrase ‘rheumatoid cachexia’ to describe the loss of body cell mass (BCM) that may occur among patients with rheumatoid arthritis (RA). Specifically, rheumatoid cachexia is characterized by altered energy and protein metabolism (reduced total energy expenditure, increased resting energy expenditure and increased whole-body protein catabolism) and increased inflammatory cytokine production (interleukin-1{beta} and tumour necrosis factor-{alpha}). Patients with rheumatoid cachexia consistently have a diet that appears adequate in protein and calories (based on US Dietary Reference Intakes), but with reduced physical activity. These phenomena are similar to some of the metabolic abnormalities that occur with normal ageing, but the aetiology appears to be different in RA. This review will focus on describing the metabolic abnormalities observed in rheumatoid cachexia, identifying potential mechanisms for loss of BCM and discussing strategies for intervention.

Keywords: Rheumatoid arthritis; Cachexia; Protein metabolism; Muscle; Body cell mass; Interleukin-1{beta}; Tumour necrosis factor-{alpha}; Exercise.
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