Unifying Concepts

Diagnostic Criteria for Rheumatoid Cachexia

Cachexia in RA (rheumatoid cachexia, RC), is mainly characterized by loss of muscle mass, in particular appendicular lean mass (ALM), and associated with accumulated fat mass (FM), situated mainly in the trunk area, indicating a shift towards the development of abdominal obesity. The loss of body cell mass (BCM) consists of an important issue of concern for patients with RA. BCM consists primarily of muscle and visceral mass (erythrocytes, serum proteins, lymphocytes, etc.), and is the part of the body with the greatest metabolic activity (95% of the total activity), determining protein requirements, energy expenditure, and the metabolic response to stress.

Diagnostic criteria for RC differed greatly between studies, with several researchers adopting the Engvall criteria, some diagnosing RC using the Elkan criteria and others the Müller criteria for RC diagnosis.

Diagnostic Criteria for Rheumatoid Cachexia

Diagnosis Author BW loss† FFMI (kg/m2) FMI (kg/m2) BF
(% of BW)
Fatigue Anorexia Abnormal
Engvall <10 PC* >25th PC*
Elkan <25 PC* >50th PC*
Müller ALM/height2
<20th PC*
>25% for
>35% for
Cachexia Evans ≥5% in the previous
12 months,
or less in the
presence of illness,
or BMI <20 kg/m2,
plus 3/5 of the other
criteria (on
the right columns)
<10th PC*,
or ASMI (by
DXA) <7.25
in men and
<5.45 in
+ +
Limited food intake (i.e. EI<20 kcal/kg of BW/day, or <70% of usual food intake), or poor appetite
° Elevated inflammatory
markers (CRP>5.0 mg/L, or IL-6 >4.0 pg/mL)
° Anaemia (Hb <12 g/dL)
° Serum albumin <3.2 g/dL

ALM: appendicular lean mass (the sum of the lean tissue in the arms and legs: calculated by DXA); ASMI: appendicle skeletal muscle index; BMI: body mass index; BF: body fat; BW: body weight; CRP: c-reactive protein; DXA: dual-energy x-ray absorptiometry; EI: energy intake; Hb: haemoglobin; FMI: fat mass index; FFMI: fat-free mass index; IL-6: interleukin 6; PC: percentile; * of the sex-, age-, and ethnic-specific values; †: oedema free.



  1. Efthymiou E, Grammatikopoulou MG, Gkiouras K, Efthymiou G, Zafiriou E, Goulis DG, Sakkas LI, Bogdanos DP. Time to Deal with Rheumatoid Cachexia: Prevalence, Diagnostic Criteria, Treatment Effects and Evidence for Management. Mediterr J Rheumatol. 2022 Sep 30;33(3):271-290. [Medline]
  2. Hurtado-Torres GF, González-Baranda LL, Abud-Mendoza C. Rheumatoid cachexia and other nutritional alterations in rheumatologic diseases. Reumatol Clin. 2015 Sep-Oct;11(5):316-21. [Medline]


Created Mar 13, 2023.

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