Skeletal muscle disease in rheumatoid arthritis: the center of cardiometabolic comorbidities?

Journal Article (Journal Article;Review)

PURPOSE OF REVIEW: Despite its critical roles in body movement, structure, and metabolism, skeletal muscle remains underappreciated in the context of rheumatoid arthritis. In rheumatoid arthritis, chronic inflammation, physical inactivity, and medication toxicities impair skeletal muscle. These skeletal muscle alterations contribute to continued rheumatoid arthritis disparities in physical function and cardiometabolic health. RECENT FINDINGS: In the prebiologic disease-modifying antirheumatic drug era, rheumatoid arthritis skeletal muscle atrophy was the central feature of 'rheumatoid cachexia,' a hypermetabolic state driven by chronic systemic inflammation and muscle protein degradation. In the current era, rheumatoid arthritis muscle deficits are less visible, yet persist as a key component of 'sarcopenic obesity.' In rheumatoid arthritis sarcopenic obesity, chronic inflammation, physical inactivity, and medication toxicities contribute to muscle contractile deficits, inflammation, altered metabolism, and intramuscular adiposity, a key predictor of rheumatoid arthritis disability and insulin resistance. SUMMARY: Rheumatoid arthritis skeletal muscle disease in the current era is defined by impaired contractile function (poor strength and endurance) and sarcopenic obesity (decreased muscle mass, increased fat mass, and intramuscular adiposity). These muscle impairments contribute to disability and cardiometabolic disease in rheumatoid arthritis. Management should focus on monitoring of rheumatoid arthritis muscle function and body composition, limiting potentially myotoxic drugs, and prescription of exercise training.

Full Text

Duke Authors

Cited Authors

  • Andonian, BJ; Huffman, KM

Published Date

  • May 2020

Published In

Volume / Issue

  • 32 / 3

Start / End Page

  • 297 - 306

PubMed ID

  • 32141950

Electronic International Standard Serial Number (EISSN)

  • 1531-6963

Digital Object Identifier (DOI)

  • 10.1097/BOR.0000000000000697


  • eng

Conference Location

  • United States