Frailty in rheumatoid arthritis and the general population: a cross-sectional analysis of the Groningen Frailty Indicator and Fried criteria.

OBJECTIVE

To compare frailty prevalence and factors driving frailty between older adults with RA and controls, using two conceptually distinct frailty instruments.

METHODS

Cross-sectional data from the Studying Ageing in Rheumatoid Arthritis (STAR) study were used, including 207 patients with RA and 214 population controls aged 55-85 years. Frailty was assessed using the Groningen Frailty Indicator (GFI; 15 yes/no items; physical, cognitive, social, psychological domains; frail ≥ 4/15) in all participants and the Fried criteria (five yes/no items; physical domain; prefrail = 1-2, frail ≥ 3, and combined frail/prefrail ≥ 1 deficit) in a clinically assessed subgroup (RA: n = 88, controls: n = 96). Prevalence and overlap between instruments were described by group. Uni- and multivariable logistic (GFI: frailty vs robust) and Poisson (Fried: frail/prefrail vs robust) regressions assessed effects of age, group, the age*group interaction and additional covariates.

RESULTS

Frailty prevalence was higher in RA than controls for GFI-frailty (34% vs 18%) and Fried-frailty/prefrailty (72% vs 50%). Among GFI-frail persons, 88% of patients with RA compared with 69% of controls were also frail or prefrail by Fried. Age was not associated with frailty in uni- or multivariable analyses for either instrument, in RA or controls (pinteraction age*group >0.10). The association with RA became insignificant after multivariable adjustment. Living alone, comorbidity score ≥1, higher fatigue and anxiety were associated with GFI-frailty, and higher BMI and poorer physical function with Fried-frailty/prefrailty.

CONCLUSION

Older adults with RA show higher (pre)frailty prevalence than controls, which is associated with disease-related consequences and vulnerability rather than age, questioning the added value of frailty assessment beyond routine clinical evaluation.