Abstract
Rheumatoid arthritis (RA) is a progressive articular disease. In addition to damaging the joints, it may cause multiple organ complications, and considerably impair the patient’s functioning. Elderly patients with RA report pain, fatigue, mood disorders, sleep disorders and insomnia, accompanied by weakness, poor appetite, and weight loss. All these factors combined have an adverse effect on the patient’s perceived quality of life (QoL). Due to the chronic nature of RA and the high risk of malnutrition in this patient group, the present study investigated QoL, activities of daily living, and frailty syndrome severity in relation to MNA (Mini Nutritional Assessment) questionnaire scores among elderly RA patients. The study included 98 patients (aged over 60) diagnosed with RA per the ARA (American Rheumatism Association) criteria. The following standardized instruments were used: WHOQoL-BREF for QoL, the Edmonton Frail Scale for frailty syndrome severity, MNA for nutritional status assessment, and MMSE (Mini-Mental State Examination) to assess any cognitive impairment. Medical data were obtained from hospital records. Patients with a different nutritional status differed significantly in terms of limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). Higher levels of malnutrition were associated with greater limitations in activity. An adverse impact of lower body weight on cognitive function was also observed (dementia was identified in 33.33% of malnourished patients vs. 1.79% in patients with a normal body weight). Likewise, frailty was more common in malnourished patients (mild frailty syndrome in 33.3%, moderate in 16.67%, and severe in 16.67%). Malnourished patients had significantly lower QoL scores in all WHOQoL-BREF questionnaire domains than those with a normal body weight, and multiple-factor analysis for the impact of selected variables on QoL in each domain demonstrated that frailty was a significant independent determinant of poorer QoL in all domains: perceived quality of life (β = −0.069), perceived health (β = −0.172), physical domain (β = −0.425), psychological domain (β = −0.432), social domain (β = −0.415), environmental domain (β = −0.317). Malnutrition was a significant independent determinant of QoL in the “perceived health” domain (β = −0.08). In addition, regression analysis demonstrated the positive impact of male sex on QoL scores in the psychological (β = 1.414) and environmental domains (β = 1.123). Malnourished patients have a lower QoL than those with a normal body weight. Malnutrition adversely affects daily functioning, cognitive function, and the severity of frailty syndrome. Frailty syndrome is a significant independent determinant of poorer QoL in all WHOQoL BREF domains.
Highlights
Rheumatoid arthritis (RA) is a chronic polyarticular inflammatory disease affecting 1% of the total population [1]
The Mini Nutritional Assessment (MNA) scores in our study were interpreted in accordance with the key and 57.14% patients were found to have a normal nutritional status, 36.73% were at risk of malnutrition, and 6.12% were malnourished
A comparative analysis of the socio-demographic characteristics of the patients studied and their nutritional status demonstrated that malnourished patients were significantly more likely to suffer from colorectal disease (50% vs. 13.9% vs. 11.8%; p = 0.001) compared to those RA patients who were well-nourished or at risk of malnutrition (Table 1)
Summary
Rheumatoid arthritis (RA) is a chronic polyarticular inflammatory disease affecting 1% of the total population [1]. As well as damaging the joints, it may cause multiple organ complications, and restrict a patient’s physical, psychological, and social functioning to a considerable extent. Besides difficulties in daily activities, patients complain of pain, fatigue, mood disorders, and insomnia. Nutritional parameters are related to disease activity and glucocorticoid treatment. Prolonged use of these may cause intestinal problems such as irritation, ulcers, acid reflux and even kidney failure. Thirty two percent of patients with RA experience rheumatoid cachexia, as a result of joint destruction, subsequent muscle inactivity, high levels of sarcoactive inflammatory cytokines—incl tumor necrosis factor α (TNF) -α and interleukin (IL) 1β, loss of muscle mass and strength and the accompanying increase in fat mass are very common in patients with rheumatoid arthritis. Factors used commonly in RA to tamper down inflammation, including TNF inhibitors and the IL 6 receptor blocker, further aggravate body protein and energy metabolism, inducing body composition alterations [11]
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