Frailty carries an increased risk of death in rheumatoid arthritis

Frailty is prevalent among people with rheumatoid arthritis (RA) and is a risk factor for adverse outcomes, however the association between frailty and mortality in RA is not well understood.

Participants from the Veterans Association Rheumatoid Arthritis (VARA) Registry enrolled from 1/2003 to 12/2020 were included. Frailty was measured using the VA Frailty Index (VA-FI) which categorized participants as robust, pre-frail, mildly frail, and moderate/severely frail. Multivariable Cox proportional hazard modeling evaluated the relationship between baseline frailty and mortality, adjusted for demographics, disease activity, smoking, and disease treatments.

2792 Veterans were included with mean age of 64.3 years. 2457 (88 %) were male and 459 (17 %) were Black. Of these, 883 (32 %) were robust, 1112 (40 %) prefrail, 520 (19 %) mildly frail, and 277 (10 %) moderately to severely frail. In total, 1283 (46 %) of participants died during the 20 years of observation. The risk of mortality increased with increasing levels of frailty - prefrail aHR 1.46 [95 % CI 1.25 - 1.69], mild frailty aHR 1.97 [95 % CI 1.66 - 2.33], moderate/severe frailty aHR 2.93 [95 % CI 2.39 - 3.59]. The VA-FI frailty domains with the highest association with mortality were morbidities and functional impairments.

There is a stepwise increase in mortality risk and decrease in survival time, associated with higher degrees of frailty in RA. Morbidities and functional impairments are associated with the greatest risk increase of mortality. The VA-FI may serve as an important prognostic tool in the RA population.