Background/Purpose: Frailty, a state of decreased physiological reserve and heightened vulnerability to stressors, occurs prematurely in rheumatoid arthritis (RA) and is associated with poor health outcomes. The concept of “resilience,” defined as the ability to draw on internal and external resources to cope with stress, is inversely associated with frailty in the general population. We evaluated the relationship between resilience and frailty in RA.

Methods: Data were from a single-center RA longitudinal cohort. The outcome, frailty, was measured using the Fried Frailty Phenotype (FFP)1 which assessed hand grip strength, exhaustion, walking, physical activity, and weight loss. The FFP was categorized as robust, prefrail, and frail. The predictor, resilience, was measured using the Resilience In Midlife (RIM) questionnaire2 and assessed self-efficacy (0-40), coping/adaptability (0-16), perseverance (0-16), internal locus of control (0-12), and family/social support (0-28); total scores ranged 0-100, with higher scores indicating greater resilience. Scores were divided by 10 and grouped into tertiles to describe the cohort. Patient-reported behavioral characteristics including stress, anxiety, depression, sleep, and cognition were also collected. Unadjusted and adjusted ordinal logistic regression was used to assess the cross-sectional relationship between continuous resilience score and frailty level. These models were repeated to assess the relationship between the individual resilience category scores and frailty level. Models were adjusted for age and sex.

Results: 127 participants were included, aged 64.5±11.8 years, 73% male, and 71% White (Table 1). Those in the lowest resilience tertile had numerically greater pain (5.5±2.5 vs. 3.7±3.6), stress (7.2±2.9 vs 2.0±1.9) and sleep scores (1.4±0.8 vs 0.7±0.8) and were more likely to be exhausted (76% vs. 29%) than the highest tertile. Those who had low resilience also had higher prednisone dosage (1.1±3.5 mg vs. 0.5±1.5 mg) and were more likely to be on bDMARDs (61% vs 46%) than those with high resilience. For every 10% increase in resilience, the odds of being in a higher frailty category decreased by 40% (aOR: 0.60 [0.46-0.78] p< 0.001) (Table 2). Although all resilience categories had an inverse relationship with frailty, only the coping/adaptability (aOR 0.12, p< 0.001), perseverance (aOR 0.16, p=0.004), and self-efficacy (aOR 0.33, p< 0.001) categories reached statistical significance (Figure 1).

Conclusion: Greater resilience was associated with a lower odds of physical frailty in RA, suggesting that coping strategies and the ability to utilize internal resources to cope with stress may be protective against frailty. Future work should examine the longitudinal relationship between resilience and frailty.Fried, L.P. et al. J Gerontol A Biol Sci Med Sci. 2001Ryan, L. and Caltabiano, M.L. Asian Social Science. 2009.

Table 1. Participant demographics, rheumatoid arthritis disease characteristics, frailty, and behavioral characteristics, stratified by resilience score tertile (N&#3f127).

Table 2. Unadjusted and adjusted ordinal logistic regression models evaluating the association of resilience score and frailty level (N&#3f127).

Figure 1. Multivariable ordinal logistic regressions evaluating the association between resilience category and frailty status (N&#3f127). Odds ratios represent odds of higher frailty level per unit increase in the resilience category. Models are adjusted for age and sex. Resilience category scores were each divided by 10.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-balancing-act-the-interplay-between-resilience-and-frailty-in-rheumatoid-arthritis/