Why Rheumatoid Arthritis Frailty Matters

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What is rheumatoid arthritis frailty?

The word frailty suggests a serious level of health vulnerability. In medical terms, frailty often describes a range of conditions in elderly people: “frailty comprises a collection of biomedical factors which influences an individual’s physiological state in a way that reduces his or her capacity to withstand environmental stresses.”1 Frailty expresses the degree to which a person can survive minor physical stressors such as a fall or an infection; it is closely related to “homeostatic reserve.” Rheumatoid arthritis frailty is a newer concept.

People with rheumatoid disease (PRD) are often heard saying they “feel like a 90-year old.” Studying rheumatoid arthritis frailty might make a lot of sense to them.

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Rheumatoid arthritis frailty posters at ACR

Why Rheumatoid Arthritis Frailty MattersA poster at the 2015 American College of Rheumatology (ACR) annual meeting, Serum inflammation identifies increased risk of frailty in rheumatoid arthritis, addressed the recent concept of rheumatoid arthritis frailty.2 Andrews et al. found: “Frailty and pre-frailty were common in our cohort of individuals with RA, with a greater prevalence than that of geriatric populations.”

In another poster called Frailty is associated with decreased physical function in adults with rheumatoid arthritis3 at the 2016 ACR meeting, Andrews et al. reported assessment of frailty in RA using the following five parameters:

  • BMI less than or equal to 18.5
  • Low grip strength for sex and BMI
  • Severe fatigue (by Fatigue Severity Inventory)
  • Slow 4-meter walking speed (adjusted for sex and height)
  • Low physical activity, as measured by IPAQ

Scoring is by the number of “deficits” a PRD experiences. A total of zero deficits generates a score of “robust.” One to two deficits generates a score of “pre-frail.” And three of more deficits gets a “frail” rating. They also used a HAQ (Health Assessment Questionnaire) and a VLA (Valued Life Activities) scale.

Findings in rheumatoid arthritis frailty

Frailty and pre-frailty were common in our cohort of individuals with RA, with a greater prevalence than that of geriatric populations… These findings underscore the high burden of frailty among individuals with RA, and they may suggest a clinical role for serum ESR and CRP in identifying individuals with RA at greatest risk of frailty.”2

Andrews et al. found that frailty is common with RA. Rheumatoid arthritis frailty is associated with higher inflammation markers and worse physical function. And frailty has an effect on disability that is separate from pain, but is similar in extent to pain’s effect. They recommend that rheumatoid arthritis frailty be studied further.

In 2017, a longer article was published by the same team, “Frailty and reduced physical function go hand in hand in adults with rheumatoid arthritis: a US observational cohort study.4 They found “Among adults with RA, being frail compared to being robust was associated with a 0.44 worse VLA score (p < 0.01) when the effects of covariates are held constant” meaning frailty impacted valued life activities.

Another RA frailty report:

“Prevalence of frailty in this study was unexpectedly high”5

In Mexico, investigator Barile-Fabris et al. also examined rheumatoid arthritis frailty.5 Of 500 people with rheumatoid disease, 23.4% met frailty criteria. Frail patients were more likely to be diagnosed with comorbidities and use multiple prescription medications. They acknowledge that both of these factors relate to disease severity.

Frailty unexpectedly high in #rheum disease. Greater prevalence than with the elderly. Click To Tweet

What do you think of RD / RA frailty?

I don’t know about you, but I was very strong before I became sick with rheumatoid disease. This is the first time I have learned about RD / RA frailty. On a personal note, I think it is a good thing to recognize effects of systemic disease so that they may possibly be considered in treatment. On the other hand, it is sad to acknowledge a miserable vile disease (as my friend Elizabeth calls it) that’s destructive in more ways than people have pondered measuring.

HAVE YOU HEARD OF FRAILTY? DOES LIVING WITH RD / RA MAKE PEOPLE MORE FRAIL?

Recommended reading

FOOTNOTES

1Lally F, Crome P. Understanding frailty. Postgrad Med J, 2007 Jan[cited 2017 Mar 2];83(975):16-20. DOI:10.1136/pgmj.2006.048587

2Andrews JS, Wahl ER, Schmajuk G, Yelin EH, Katz PP. Serum inflammation identifies increased risk of frailty in rheumatoid arthritis [abstract]. Arthritis Rheumatol. 2015[cited 2017 Mar 2];67 (suppl 10). Available from: http://acrabstracts.org/abstract/serum-inflammation-identifies-increased-risk-of-frailty-in-rheumatoid-arthritis/

3Andrews J, Covinsky K, Hough C, Trupin L, Yelin EH, Katz PP. Frailty is associated with decreased physical function in adults with rheumatoid arthritis [abstract]. Arthritis Rheumatol. 2016[cited 2017 Mar 6];68 (suppl 10). Available from: http://acrabstracts.org/abstract/frailty-is-associated-with-decreased-physical-function-in-adults-with-rheumatoid-arthritis/

4Andrews JS, Trupin L, Yelin EH, Hough CL, Covinsky KE, Katz PP. Frailty and reduced physical function go hand in hand in adults with rheumatoid arthritis: a US observational cohort study. Published online 2017 Jan 23[cited 2017 Mar 6]. Clin Rheumatol. DOI:10.1007/s10067-017-3541-9

5Barile-Fabris LA, Pérez-Cristobal M, Merlos-López RJ, Xibillé-Friedman D. Frailty syndrome in patients with rheumatoid arthritis. Rev Med Inst Mex Seguro Soc. 2016[cited 2017 Mar 2];54 Suppl 2:S210-5. Abstract in English available from: https://www.ncbi.nlm.nih.gov/pubmed/27561027

Clegg A, Young J, Iliffe S, Olde Rikkert MO, Rockwood K. Frailty in Older People. Lancet. 2013 Mar 2[cited 2017 Mar 7];381(9868):752–762. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098658/

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Kelly Young. All rights reserved.

This entry was posted on Tuesday, March 7th, 2017 at 10:06 am and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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