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Rheumatoid arthritis (RA) is an inflammatory arthritis that can lead to a metabolic state called rheumatoid cachexia, or muscle wasting. This condition is characterised by a loss of muscle mass and strength, which can add to the tired and achy feeling associated with RA. While the exact causes of rheumatoid cachexia are unknown, it is believed to be caused by a combination of factors, including chronic inflammation, lack of physical activity, oxidative stress, and nutritional deficiencies. Similarly, osteoarthritis (OA) patients also experience muscle wasting, which is believed to be caused by inflammation and molecular mechanisms related to gene expression and epigenetic modifications.
| Characteristics | Values |
|---|---|
| What is it called? | Rheumatoid cachexia |
| What does it refer to? | Loss of muscle mass and strength |
| What causes it? | Chronic inflammation, lack of physical activity, high plasma concentrations of inflammatory cytokines, oxidative stress, and genetic factors |
| What are the symptoms? | Tiredness, muscle weakness, difficulty performing everyday tasks, higher resting energy expenditure, quicker whole-body protein catabolism, and sarcopenia |
| How common is it? | About two-thirds of people with RA experience this complication if they don't control their RA |
| Can it be treated? | Yes, with exercise (especially resistance training) and potentially with dietary changes (e.g., adding fish oil) and medical treatments |
| What are the risks of not treating it? | It can cause serious complications like heart disease and may lead to a shorter life expectancy |
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What You'll Learn
Rheumatoid arthritis (RA) and muscle wasting
Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis and can lead to functional and social disability. RA affects several tissues in the body, including muscles, and patients with RA have significantly less muscle mass than the general population. This loss of muscle mass is known as rheumatoid cachexia or muscle wasting.
RA patients experience muscle wasting due to a combination of high plasma concentrations of inflammatory cytokines, nutrition, and physical activity. Cytokines are proteins produced by the immune system, and high concentrations of TNF-α, IL-1, and IL-6 are thought to trigger muscle wasting. TNF-α inhibits skeletal muscle differentiation and regeneration, while IL-1 prevents the anabolic effects of insulin growth factor 1 on muscle protein synthesis. In addition, IL-6 has been shown to cause net muscle protein degradation in healthy individuals.
Nutrition and physical activity also play a role in muscle wasting in RA patients. Patients with RA often experience discomfort and reduced mobility, leading to decreased physical activity and muscle wasting. Additionally, RA patients may become depressed, eat less, and lose weight, further contributing to muscle wasting. Obesity may also be a factor, especially with a diet high in saturated fat.
The exact causes of muscle wasting in RA are not fully understood, and oxidative stress may also be a contributing factor. Exercise, particularly resistance training, can help halt or reverse muscle wasting and improve other aspects of the disease. Additionally, studies have shown that adding fish oil to the diet can improve muscle strength and reduce fatigue.
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Exercise as a treatment for muscle wasting
Muscle wasting, also known as muscle atrophy, is a condition that causes loss of mass and strength in the muscles. It can be caused by various factors such as injury, immobility, lack of physical activity, and malnutrition. People with rheumatoid arthritis (RA) are particularly susceptible to muscle wasting due to the inflammatory nature of the disease.
Exercise is a crucial treatment for muscle wasting, as it can slow down muscle loss, enhance strength and mobility, and improve overall physical functionality. The most suitable exercise plan will depend on individual needs and preferences. Resistance training, for example, can be done in water to reduce the impact on joints while building lean muscle mass and increasing the range of motion. Even simple enhancements to daily physical activity can be beneficial for those with muscle wasting.
For individuals with arthritis, exercise can be an effective way to fight muscle wasting. Studies have shown that exercise can not only halt or reverse muscle wasting but also treat other aspects of the disease. In addition to recommended RA medications, exercise can be a powerful supplement to improve overall health.
The molecular mechanisms of muscle wasting in arthritis are not yet fully understood, but they are believed to be related to changes in gene expression and epigenetic modifications. Inflammation, nutrition, and physical activity are also thought to play a role in muscle wasting in arthritis. Exercise has been shown to influence these mechanisms and slow muscle wasting. For example, resistance exercise training has been found to reduce whole-muscle TNFα protein and mRNA in frail individuals, which can help to prevent muscle wasting.
In summary, exercise is a critical treatment for muscle wasting, particularly in individuals with arthritis. By adopting specific exercises targeting muscle wasting, individuals can improve their physical strength and mobility while also enhancing their overall fitness and well-being.
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RA and chronic inflammation
Rheumatoid arthritis (RA) is a chronic inflammatory form of arthritis that causes joint pain, swelling, and damage. It occurs when the immune system malfunctions and attacks the lining of the joints, called the synovium. RA is the most common inflammatory arthritis and can lead to functional and social disability. In addition to the joints, RA affects several other tissues in the body, including the muscles.
RA patients experience significantly less muscle mass compared to the general population, and this condition is referred to as rheumatoid cachexia or muscle wasting. About two-thirds of people with RA experience muscle wasting if their RA is not controlled. Muscle wasting adds to the fatigue and achy feeling associated with RA and can lead to serious complications such as heart disease and reduced life expectancy.
High-grade inflammation has long been proposed as the primary driver of muscle wasting in RA. RA is associated with high plasma concentrations of inflammatory cytokines such as TNF-α, IL-1, and IL-6, which are thought to trigger muscle wasting. TNF-α activation leads to the inhibition of skeletal muscle differentiation and regeneration. IL-1 prevents the anabolic effects of insulin growth factor 1 (IGF-1) on muscle protein synthesis and myogenin expression. Intravenous infusion of IL-6 in healthy individuals resulted in net muscle protein degradation. However, recent findings suggest that inflammation alone cannot fully explain the high prevalence of muscle wasting in RA.
Other factors, such as nutrition and physical activity, have been studied in relation to muscle wasting in RA. Malnutrition is observed in some RA patients with muscle wasting, but simply eating more is not a solution because the affected muscles do not absorb nutrition properly. Resistance training, on the other hand, has been shown to be beneficial. It builds lean muscle mass, increases the range of motion, decreases arthritis pain, aids in weight loss, and reduces the risk of falling. Studies have also shown that adding fish oil to the diet can improve weight and muscle strength and reduce fatigue.
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RA and loss of muscle strength
Rheumatoid arthritis (RA) is the most common inflammatory arthritis and can lead to functional and social disability. RA patients have significantly less muscle mass and strength compared to the general population. This loss of muscle strength and mass is called rheumatoid cachexia or muscle wasting. About two-thirds of people with RA experience this complication if they don’t control their RA.
RA patients often present with low muscle mass and decreased strength. Muscle strength was lower in all RA groups compared with healthy controls, even in patients who had achieved long-term remission. RA patients also showed a decrease in strength at a faster rate than the loss of muscle mass. This highlights the importance of assessing not only muscle mass but also muscle strength.
Inflammation, nutrition, and physical activity are some of the factors that contribute to muscle wasting in RA. High plasma concentrations of inflammatory cytokines implicated in RA pathophysiology (TNF-α, IL-1, and IL-6) are thought to trigger muscle wasting. TNF-α-induced activation of the classical NFκB pathway leads to inhibition of skeletal muscle differentiation and regeneration in a variety of muscle diseases. IL-1 has been shown to prevent the anabolic effect of insulin growth factor 1 (IGF-1) on myoblast differentiation, muscle protein synthesis, and myogenin expression. Intravenous infusion of IL-6 in healthy volunteers led to net muscle protein degradation.
Oxidative stress is another major mechanism thought to contribute to the development and progression of RA. It has been shown to promote muscle wasting in healthy populations and people with several chronic conditions. All of the aforementioned potential contributors to muscle wasting in RA (i.e., inflammation, nutrition, and physical activity) may promote pro- or anti-oxidative mechanisms.
Exercise is an effective way to combat muscle wasting in RA. Resistance training, in particular, can build lean muscle mass and increase the range of motion, allowing for easier movement. It has also been shown to decrease arthritis pain, help people lose weight, and reduce the incidence of falling. Progressive resistance exercise is another effective therapy for muscle wasting in RA, although it may be challenging or unsuitable for some individuals.
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RA and oxidative stress
Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that affects the diarthrodial joints. It is characterised by erosive synovitis, which causes cartilage and bone destruction and systemic complications, including cardiovascular, pulmonary, psychological, and other skeletal disorders.
Oxidative stress is caused by an imbalance between the production and accumulation of oxygen reactive species (ROS) in cells and tissues, and the ability of a biological system to detoxify these reactive products. ROS are highly reactive chemicals formed from diatomic oxygen (O2), water, and hydrogen peroxide. They are normally generated as by-products of oxygen metabolism, but their production is greatly increased by environmental stressors such as UV radiation, pollutants, and heavy metals.
Oxidative stress is an active process in RA pathogenesis, interrelated to other pathogenic elements. Inflammation increases the production of ROS, which may explain why RA is one of the diseases that induce oxidative stress. Free radicals play an important role in the inflammatory and immunological cellular response in RA. They can also directly degrade joint cartilage, attacking its proteoglycan and inhibiting its synthesis.
Studies have shown that glutathione peroxidase (GPx), ROS, calcium (Ca) and phosphorus (P) ions, vitamin C and D, and lipid profiles could serve as potential diagnostic markers in the early stages of RA. Antioxidant systems, either enzymatic or not, are impaired in RA.
In summary, oxidative stress is implicated in the pathogenesis of RA, and understanding the role of oxidants and antioxidants in RA patients could improve our understanding of the disease and its progression.
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Frequently asked questions
Rheumatoid cachexia, or muscle wasting, is a metabolic state that people with rheumatoid arthritis (RA) can develop due to chronic inflammation and a lack of physical activity.
People with rheumatoid cachexia may experience muscle weakness and find it difficult to perform everyday tasks. They may also have a higher resting energy expenditure, quicker whole-body protein catabolism, and higher levels of inflammatory cytokines.
Yes, rheumatoid arthritis (RA) can cause muscle wasting, also known as rheumatoid cachexia. About two-thirds of people with RA experience this complication if they don't control their RA. Muscle wasting can add to the tired and achy feeling associated with RA and can lead to serious complications such as heart disease.
