Longitudinal Frailty Status in Rheumatoid Arthritis and Its Association With Disease Activity and Glucocorticoid Use

Area of Science:

• Rheumatology
• Gerontology
• Clinical Medicine

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease.
• Frailty is a growing concern in aging populations, particularly those with chronic conditions like RA.
• Understanding factors contributing to long-term frailty in RA is crucial for effective patient management.

Purpose of the Study:

• To identify factors associated with long-term frailty in patients with rheumatoid arthritis (RA).
• To investigate the relationship between frailty status, disease characteristics, and treatment patterns in RA patients over time.

Main Methods:

• Analysis of 313 RA patients with complete annual Japanese version of the Cardiovascular Health Study (J-CHS) assessments from 2020-2025.
• Frailty status determined by mean J-CHS score, classifying patients into two groups (mean J-CHS ≤ 2 and > 2).
• Logistic regression used to identify factors associated with higher frailty status (mean J-CHS > 2).

Main Results:

• Patients with higher frailty (mean J-CHS > 2) were older, had longer disease duration, higher disease activity (DAS28-ESR), higher glucocorticoid use, and worse physical function (HAQ-DI).
• Independent factors associated with higher frailty included longer disease duration, higher DAS28-ESR, and glucocorticoid use.
• Longitudinal analysis revealed consistently higher glucocorticoid use in frailer patients, even among those in remission with comparable disease activity.

Conclusions:

• Long-term frailty in RA is significantly associated with disease duration and treatment patterns, especially persistent glucocorticoid exposure.
• Higher glucocorticoid use in frailer patients persists even in remission, suggesting potential differences in treatment strategies.
• These findings highlight the need to monitor frailty and reconsider glucocorticoid management in RA patients.