Why Rheumatoid Arthritis Frailty Matters | Rheumatoid Arthritis Warrior

Why Rheumatoid Arthritis Frailty Matters

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.


Recommended reading


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/

Kelly O'Neill

Kelly O'Neill (formerly Kelly Young) has worked about 12 years as an advocate helping patients to be better informed and have a greater voice in their healthcare. She is the author of the best-selling book Rheumatoid Arthritis Unmasked: 10 Dangers of Rheumatoid Disease. Kelly received national acknowledgement with the 2011 WebMD Health Hero award. She is the president of the Rheumatoid Patient Foundation. Through her writing and speaking, she builds a more accurate awareness of rheumatoid disease (RD) aka rheumatoid arthritis (RA) geared toward the public and medical community; creates ways to empower patients to advocate for improved diagnosis and treatment; and brings recognition and visibility to the RA patient journey. In addition to RA Warrior, she writes periodically for newsletters, magazines, and websites. There are over 60,000 connections of her highly interactive Facebook page. You can also connect with Kelly on Twitter or YouTube, or LinkedIn. She created the hashtag: #rheum. Kelly is a mother of five, longtime home-schooler, NASA enthusiast, and NFL fan. She has lived over fourteen years with unrelenting RD. See also https:/rawarrior.com/kelly-young-press/

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9 thoughts on “Why Rheumatoid Arthritis Frailty Matters

  • March 7, 2017 at 11:05 am

    My RA frailty fluctuates depending in when it attacks and partial remission gets disrupted.

  • March 7, 2017 at 12:57 pm

    I feel frail today after a busy weekend. I felt frail then too but I pushed through and of course I am at a standstill today. The thing with RA frailty is that I don’t look frail – people tell me I look well. So if I say i’m having a rough time it must sound ridiculous.

  • March 7, 2017 at 1:35 pm

    I have RA/RD,along with several other medical additions that decided to tag along for the ride, I don’t see myself as frail,but maybe others see something I don’t. I think my attitude helps me to keep my sense of humor about all of this…

  • March 7, 2017 at 8:00 pm

    I noticed it right away. I’ve never heard a name for it. My strength continues to decline. I’m quite concerned about it and have considered myself “frail” for years.

    • March 8, 2017 at 12:13 am

      Thanks Bill.
      Do you have any specific examples of what you notice as frail or strength decline?

  • March 8, 2017 at 2:34 pm

    This article touched me in a deep way.
    Just needed to hear it from someone else.

  • March 11, 2017 at 7:31 pm

    Yes! This is HUGE problem for me. I am 48, I had Juv. R.A and went into remission for years. After I had my kids, I was diagnosed with Type 1 diabetes. About 5 years after that my R.A. symptoms started to reappear. I was SO active and now I have NO energy, yet still have to keep after my 2 kids and everyday life. I am struggling just to get up, shower, dress, get kids off to school..shop..cook, etc. !
    Then the weekends come and I have to TRY to find the energy to go have fun with the kids. Try to have energy to have fun? Thats something I NEVER thought Id have to do! Too many times I have to say NO to fun bc if I do too much…I KNOW Ill get a bad flare and then Ill be down for days! I cant do that when I have kids to take care of! I try to explain to Doctor and they say..basically NOTHING to help! The pain Ive learned to deal with…but giving up SO much of my life bc of the Frailty of this dumb disease is literally killing me! So…YES! talk about this so that Doctors and get a CLUE to what its really like and maybe someone will start researching and try to help us!!!! If I am like this at 48, what will it be like when Im 68? And NO ONE who doesnt know about R.A understands AT ALL! They look at me like I am lazy and rude bc I always say no to going out or doing extra things! Or do they offer to help me do normal everyday things bc THEY DONT GET IT! So So Frustrating!

  • March 29, 2017 at 4:12 pm

    I am also a 40 year old with JRA. I understand. I live the same way and feel bad when I have to say no. My husband giving credit where credit is due, is amazing. He has started to recognize what he calls “my pain face” along with a few close friends. I hate it, and just want to scream” I am too young for this crap”. Just know that there are others out there who get it.
    Sending love,

  • December 15, 2017 at 8:13 am

    Never thought of it as “frailty”, but its a good descriptor. I’ve always joked I am in great shape for a 65 year old man (I am 45). I have had psoriatic arthritis (PsA) for about 8 years now. I feel I have aged dramatically. I probably fall in the pre-fail category in a strict read, but going from healthy and very active (ran a half marathon prior to this), to locked up like the tin man nearly over night feels like full on frailty to me.

    on the plus side, I have the super power if predicting bad weather a day out.


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