Frailty and Rheumatoid Arthritis: Key Insights and the Road Ahead

People with rheumatoid arthritis (RA) experience premature aging and RA is associated with poor health outcomes. Frailty tools offer a holistic view of an individual's health status that may inform treatment strategies in RA. This review provides an overview of frailty in RA including methods of measurement, associations with clinical outcomes, and potential paths for frailty intervention.

Frailty is common in RA, affecting approximately one-third of patients, with prevalence estimates varying according to the measurement instrument used. The causes of frailty are not well studied but likely include a combination of chronic systemic inflammation, immunosenescence, deconditioning and medication effects. Frailty is consistently associated with higher disease activity, poorer physical function, depression, pain, reduced quality of life, and greater comorbidity burden. Longitudinal studies show that frailty predicts hospitalization, serious infections, osteoporotic fractures, functional decline, readmission, and mortality, independent of traditional clinical risk factors and comorbidity indices. Emerging evidence also supports a bidirectional relationship between frailty and RA disease activity, suggesting that some aspects of frailty may be modifiable through improved disease control. Frailty-specific interventions have not yet been studied in RA, however, RA disease control, medication optimization and promotion of physical activity are likely to improve frailty in this high-risk population. Frailty is an important predictor of poor health outcomes in RA and may be amenable to interventions. Incorporation of frailty assessment into clinical care and clinical trials will be essential to move the field forward.