AB0617 ASSOCIATION OF FRAILTY AND PHYSICAL FUNCTION ASSESSMENT TO EXPLORE RHEUMATIC FRAILTY IN PATIENTS WITH RHEUMATOID ARTHRITIS FROM A PROSPECTIVE COHORT STUDY (2024)

Abstract

Background: Frailty is a state of increased vulnerability that may lead to physical dysfunction and the need for nursing care. Rheumatoid arthritis (RA) is a bone and joint disease that causes loss of mobility and thus contributes to frailty. Despite advances in RA treatment that have led to better control of disease activity, there is still a condition of “rheumatic frailty” that is associated with reduced activity due to frailty. It is important to clarify “rheumatic frailty” because there are many factors associated with RA and frailty, including physical function and psychological factors, as well as age and disease activity (1). However, there are few reports on frailty and physical function assessment in RA patients.

Objectives: The aim of this study was to investigate the association between frailty and physical function assessment in patients with RA.

Methods: Between March 2021 and December 2022, 324 patients who participated in a prospective cohort study on frailty in RA patients (Fairy study) were included. The bioelectrical impedance analysis (BIA) method was used to measure the total limb skeletal muscle mass index (SMI) and total body muscle mass. Physical function assessment was measured by the Timed Up and Go Test (TUG), walking speed, and five-repetition sit-to-stand (5R-STS) test. Frailty was assessed using the Kihon Checklist (KCL), and patients were divided into three groups: Robust with a total score of 0-3, Pre-Frailty with a score of 4-7, and Frailty with a score of 8 or higher (2). Patient background at enrollment, disease activity (SDAI), physical function assessment (TUG, walking speed, 5R-STS, Grip), body composition (Muscle mass, SMI), HAQ-DI, nutritional assessment (CONUT), and mental assessment (BDI-II) were compared in the three groups. Multiple logistic regression analysis was used to determine factors associated with frailty, with age, gender, BMI, disease duration, and SDAI as adjusting factors. The cutoff values for pre-frailty and frailty were calculated using ROC curves for the factors significantly associated with frailty.

Results: Of the 324 patients, 50% were Robust, 31% were Pre-Frailty, and 19% were Frailty. Patient background for each group was 62/ 63/ 68 years of age (P=0.005) and SADI was 4.33/ 5.90/ 6.28 (P=0.02). Regarding physical activity, TUG was 8.28/ 9.26/ 10.60 m/sec (P<0.01), gait speed was 1.38/ 1.22/ 1.10 m/sec (P<0.01), and HAQ-DI was 0.19/ 0.46/ 0.79 (P<0.01) (Table 1). Multiple logistic regression analysis revealed that with Robust as Reference, TUG (Pre-Frailty [OR: 1.43, 95% CI: 1.20-1.71], Frailty [OR: 1.65, 95% CI: 1.36-2.02]), walking speed (Pre-Frailty [OR: 0.14, 95% CI: 0.04-0.48], Frailty [OR: 0.03, 95% CI: 0.01-0.16]), 5R-STS (Pre-Frailty [OR: 1.16, 95% CI: 1.07-1.25], Frailty [OR: 1.19, 95% CI: 1.09-1.29]) were significantly associated with frailty (Table 2). Regarding the cutoff values for pre-frailty and frailty, TUG was 8.38/9.67 s, walking speed was 1.29/1.15 s, and 5R-STS was 10.73/10.32 s. BDI-II was 9.5/10.5 points.

Conclusion: Physical functions assessment such as TUG, walking speed, and 5R-STS in RA patients were independently associated with frailty in association with age, but not with muscle mass. Frailty was also found to be associated with psychological factors.

Acknowledgements: NIL.We thank Kaoru Nagai and Chinami Ohnishi for contributing to the physical measurements.

Disclosure of Interests: None declared.