A Weighty Matter

A work colleague made a statement yesterday that many would consider a compliment…”You’ve lost weight.” True enough, I’ve lost about 15 pounds over the past few months. The problem is, I was not purposefully trying to lose weight. There have been no dramatic changes to my diet. On the other hand, exercise had not been much of a possibility due to knee and ankle problems. One would suspect that weight gain would be in order given the lack of exercise. The topic was raised with my rheumatologist in early August and he immediately tested for thyroid problems and diabetes – two common causes of quick weight loss. But both of those tests came back negative. I’ve always been considered skinny. I weighed 129 pounds my senior year of high school (and that was probably soaking wet). Of course, age and changes in metabolism set in but I’ve remained at or below average for weight. So the mystery of the quick weight loss remains unsolved. But I’m beginning to wonder if RA is the culprit.

According to the Johns Hopkins Medical School arthritis website,

“Patients with RA are considered to be at nutritional risk for many reasons. One cause of poor nutritional status in this patient population is thought to be the result of the weight loss and cachexia linked to cytokine production. In patients experiencing chronic inflammation, the production of cytokines, such as interleukin-1 and tumor necrosis factor, increases resting metabolic rate and protein breakdown.” [i]

Interestingly, this statement is under the heading Malnutrition. The medical definition of cachexia is “Physical wasting with loss of weight and muscle mass caused by disease.” [ii] Muscle wasting is the most common cause of weight loss in RA patients. [iii] [iv] The only real proposed treatment is physical activity to keep muscle mass as increasing protein intake has no effect. [v] [vi] Treatment with a TNF blocker like Enbrel or Humira may help but studies comparing their use to methotrexate demonstrated no differences. [vii]

Perhaps my metabolism has increased as a result of RA. I’m currently on Humira, a TNF blocker and yet the weight loss continues. In the meantime, I’ll keep stepping on the scale and discuss it again with my rheumy at my next appointment. I guess I should go sign up for a membership at the local pool because no other exercise regimen seems possible at this time.

photo credit Creative Commons License  http://www.flickr.com/photos/oter/