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Rheumatoid cachexia is characterized by involuntary loss of lean body mass mainly skeletal muscle which also occurs in the viscera and immune system, with fat mass stable or slightly higher and with little or no weight loss. It is under-recognized in clinical practice and severe cases with loss of weight leads to increased morbidity and premature mortality but loss of muscle bulk with a normal body mass index also associates with poor clinical outcomes. The etiology is likely multifactorial, and involves excessive inflammatory cytokine production, namely excess tumor necrosis factor-á, and low habitual physical activity. Body composition can be analyzed using anthropometrics measurements, densitometry of total body and other techniques, but the results should be interpreted with caution. Currently MRI has been studied as an important test to define with more confidence, muscle mass and body fat distribution. Cachexia shows little response to diet alone but progressive resistance training and anti- tumor necrosis factor therapies show promise in tackling this potentially disabling extra-articular feature of RA.

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