medwireNews: Frailty is common and associated with adverse outcomes in people with rheumatoid arthritis (RA), but may be at least partially reversible in those with early disease, researchers report.
“This knowledge is incredibly beneficial for clinicians when assessing people with RA and deciding on a broad approach to treatments; and also suggests care should be taken in applying a ‘label’ of frailty to people living with RA, given the potential to reverse this following treatment,” said lead researcher Peter Hanlon (University of Glasgow, UK) in a press release.
The study, published in RMD Open, drew on a cohort of 899 people with newly diagnosed RA or undifferentiated arthritis who were included in the Scottish Early Rheumatoid Arthritis (SERA) study in 2011–2015, and 3605 patients with established RA who were recruited to the UK Biobank study in 2006–2010. The average age of the participants was approximately 59 years.
Hanlon and team found that the mean frailty index – measured on a scale of 0 (no deficits) to 1 (all possible deficits) – was 0.16 in the SERA cohort and 0.19 in the UK Biobank cohort. A total of 12.1% and 20.0% of patients registered in the SERA and UK Biobank datasets, respectively, had moderate frailty (frailty index >0.24 to 0.36), and a corresponding 0.2% and 3.0% had severe frailty (>0.36).
Among people with early RA in the SERA cohort, average frailty index at baseline increased with age and disease activity, and was higher in women than men.
The researchers then evaluated changes in frailty over 2 years of follow-up in this early RA cohort, finding that average frailty index, DAS28, and HAQ-DI scores decreased after initiating DMARD treatment. Among the 109 people with moderate or severe frailty at study entry, the average frailty index improved from approximately 0.28 at baseline to 0.22 at 2 years; 33% of these people improved to the mild frailty category (frailty index >0.12 to 0.24) and 13% to the robust category (≤0.12) during the first 6 months of follow-up.
Therefore, “[f]railty in RA is dynamic and, for some, may be ameliorated through controlling disease activity in early disease,” write the study authors.
They note, however, that despite these improvements, people with higher frailty index at baseline continued to have greater frailty and worse RA outcomes over 2 years than those with lower frailty at baseline.
In accordance with previous studies, Hanlon and colleagues found that frailty was associated with increased risk for adverse outcomes. In the SERA cohort, people with moderate or severe frailty had a significantly higher risk for all-cause mortality (hazard ratio [HR]=4.14) and unscheduled hospitalization (HR=2.27) than robust individuals during an average follow-up of 4 years after adjustment for factors including DAS28, age, sex, and smoking.
These findings “indicate that frailty has prognostic significance beyond that of high disease activity,” they write.
The associations remained consistent in the UK Biobank cohort of people with established RA, with adjusted HRs of 1.68 for mortality and 2.74 for hospitalization, but this analysis did not account for disease activity.
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