Abstract
Background: Frailty, an age-related decline in physiological reserve, is an increasingly important concept in the management of chronic diseases. The implications of frailty in people with rheumatoid arthritis are not well understood. We undertook a systematic review to assess the prevalence of frailty in people with rheumatoid arthritis, and the relationship between frailty and clinical outcomes. Methods: We searched three electronic databases (January 2001 to April 2021) for observational studies assessing the prevalence of frailty in adults (≥18 years) with rheumatoid arthritis, or analysing the relationship between frailty and clinical outcomes in the context of rheumatoid arthritis. Titles, abstracts and full texts were assessed independently by two reviewers. Study quality was assessed using an adapted Newcastle-Ottawa Scale. Results: We identified 17 analyses, from 14 different sample populations. 15/17 were cross-sectional. These studies used 11 different measures of frailty. Frailty prevalence ranged from 10% (frailty phenotype) to 36% (comprehensive rheumatologic assessment of frailty) in general adult populations with rheumatoid arthritis. In younger populations (<60 or <65 years) prevalence ranged from 2.4% (frailty phenotype) to 19.9% (Kihon checklist) while in older populations (>60 or >65) prevalence ranged from 31.2% (Kihon checklist) to 55% (Geriatric 8 tool). Frailty was associated with higher disease activity (10/10 studies), lower physical function (7/7 studies), longer disease duration (2/5 studies), hospitalization (1/1 study) and osteoporotic fractures (1/1 study). Conclusion: Our review found that frailty is common in adults with rheumatoid arthritis, including those aged <65 years, and is associated with a range of adverse features. However, these is substantial heterogeneity in how frailty is measured in rheumatoid arthritis. We found a lack of longitudinal studies making the impact of frailty on clinical outcomes over time and the extent to which frailty is caused by rheumatoid arthritis unclear.
Highlights
Rheumatoid arthritis is the most common chronic inflammatory arthropathy, the incidence of which increases with age[1,2,3]
We aim to assess (i) what frailty measures have been used in published studies including people with rheumatoid arthritis, (ii) what is the prevalence of frailty in people with rheumatoid arthritis across a range of ages, (iii) what is the association between frailty and features of rheumatoid arthritis such as disease activity, functional limitation, and duration, and (iv) if frailty is associated with adverse health outcomes in the context of rheumatoid arthritis
Frailty in people with rheumatoid arthritis has been quantified in high income countries using a wide range of different approaches and is consistently demonstrated to be common, among people with more active disease
Summary
Rheumatoid arthritis is the most common chronic inflammatory arthropathy, the incidence of which increases with age[1,2,3]. Many measures exist to quantify frailty, of which the most widely used are the frailty phenotype[6] (a physical measure assessed by grip strength, walking speed, exhaustion, weight loss, and low physical activity) and the frailty index[7,8] (a cumulative count of age-related deficits including long term conditions, symptoms, functional limitation and physiological markers). Both constructs have potential overlap with features associated with rheumatoid arthritis. Study quality was assessed using an adapted Newcastle-Ottawa Scale
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