Background/Purpose: Reduced physical function and health-related quality of life remain common in Rheumatoid Arthritis (RA), and further studies are needed that examine potential, novel determinates of reduced physical function in RA. Frailty is a state of excess vulnerability to stressors, with reduced ability to maintain or regain homeostasis after a destabilizing event. Frailty is associated with increased risk of poor health outcomes including death. The present study examines whether frailty is associated with differences in self-reported physical function among adults with RA.

Methods: Adults (n=124) from a longitudinal RA cohort participated in the study. All measures were collected during in-person research visits. Using an established definition of frailty¹, individuals with 3 or more of the following physical deficits were classified as frail: 1) body mass index ≤ 18.5, 2) low grip strength (adjusted for sex and BMI, measured by handheld dynamometer), 3) severe fatigue (measured by the Fatigue Severity Inventory), 4) slow 4-meter walking speed (adjusted for sex and height), 5) low physical activity (measured by the International Physical Activity Questionnaire). Individuals with 1 or 2 deficits were classified as “pre-frail”, and those with no deficits as “robust¹.”  Self-reported physical function was assessed by the Health Assessment Questionnaire (HAQ) and the Valued Life Activities Difficulty scale (VLA), (HAQ and VLA scored 0-3). Regression analyses modeled associations of frailty category with HAQ and VLA Difficulty scores with and without controlling for age, sex, disease duration, hsCRP, use of oral steroids, and pain. Secondary analyses tested whether associations of frailty category and physical function scores were robust to using knee strength rather than grip strength in assigning frailty category and relationships between pain, frailty category, and physical function.

Results: Among adults with RA, being frail compared to being robust was associated with a 0.54 worse HAQ score (p<0.01) and a 0.63 worse VLA score (p<0.001) when the effects of all covariates are held constant (Table 1). The association of frailty category with HAQ and VLA Difficulty scores persisted when knee strength was used to assign frailty category (Table 2).

Conclusion: Frailty is common among individuals with RA. Being frail, compared to being robust, is associated with significantly worse self-reported physical function among adults with RA. Future studies should continue to advance understanding of frailty as a potential source of reduced physical function in RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/frailty-is-associated-with-decreased-physical-function-in-adults-with-rheumatoid-arthritis/