Nutritional status and frailty in rheumatoid arthritis: A multicenter observational study (T-FLAG)

Frailty is a relevant clinical issue in rheumatoid arthritis (RA) patients, particularly as the population ages. Malnutrition, decreased physical function, and a loss of social connections are key contributors to frailty. This study aimed to investigate the association of nutritional status with frailty in RA patients, with a focus on physical function and social frailty.

This cross-sectional study examined RA patients from a multicenter cohort at three hospitals. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI). Frailty was defined using the Kihon Checklist, physical function using the Health Assessment Questionnaire Disability Index (HAQ-DI), and social frailty using the Makizako Social Frailty Index. Multivariate logistic regression was performed to identify independent associations with frailty.

A total of 667 patients were included (median age, 72 years; 73 % women). Frailty prevalence increased progressively with worsening nutritional status (GNRI), from 29.6 % in the no risk group to 66.7 % in the major risk group (P < 0.001). In multivariate models, GNRI and social frailty were significantly associated with frailty. This association, however, was no longer significant after adjusting for HAQ-DI, suggesting that physical function may influence this relationship. Stratified analysis confirmed that poor nutritional status was associated with increased frailty prevalence even among patients in HAQ remission (HAQ-DI ≤0.5).

Nutritional status is associated with frailty in RA patients, and this association may be influenced by physical function. A multidimensional approach addressing nutrition, physical function, and social factors is warranted in RA management.