P096 Analysis of frailty in rheumatoid arthritis and its relationship with disease activity, hospitalization and mortality: findings from the Scottish Early Rheumatoid Arthritis cohort and UK Biobank

Abstract

Abstract Background/Aims Frailty is present in relatively young people with rheumatoid arthritis (RA) but its association with longitudinal outcomes is unclear. This study aimed to assess the prevalence of frailty in RA and its association with disease activity, all-cause mortality, and hospitalisation. Methods People with RA identified from Scottish Early Rheumatoid Arthritis cohort (recruited at diagnosis, mean age 58.2) and UK Biobank (identified using diagnostic codes occurring prior to baseline assessment, mean age 59). Frailty was quantified using the frailty index approach (a cumulative count of age-related deficits, assessed in both datasets) and the frailty phenotype (based on low grip strength, weight loss, low physical activity, exhaustion and slow walking speed, assessed in UK Biobank only). Disease activity was assessed using DAS28-score in SERA. Relationship between baseline frailty and all-cause mortality and unscheduled hospitalization was assessed adjusted for age, sex, socioeconomic status, smoking and alcohol (model 1), plus DAS28 in SERA (model 2). In SERA, changes in frailty index, DAS28, self-rated health and HAQ-DI were reassessed after 6 months. Results Using the frailty index, frailty was common in SERA (12% moderate, 0.3% severe) and UK Biobank (20% moderate, 3% severe). In UK Biobank 23% were frail using the frailty phenotype. Frailty index was associated with DAS28, age and female sex. Both the frailty index and frailty phenotype were associated with all-cause mortality and unscheduled hospitalisation. In SERA, the relationship with hospitalisation was attenuated after adjusting for DAS28 (table). In SERA, as DAS28 fell over time with treatment, 46% of moderately frail participants improved to mildly frail or robust states after 6 months. However, despite these improvements, participants with moderate or severe frailty at baseline had higher mean DAS28, greater functional impairment, poorer self-rated health, and still had higher mean frailty index than people who were robust or mildly frail at baseline. Conclusion Frailty is common in early and established RA and associated with hospitalisation and mortality. Frailty in RA is dynamic and, for some, may be ameliorated through controlling disease activity in early disease. Future work should explore how best to identify individuals likely to benefit from specific treatment strategies. Disclosure P. Hanlon: Grants/research support; Medical Research Council Clinical Research Training Fellowship (MR/S021949/1). F. Morton: None. S. Siebert: None. B. Jani: None. J. Lewsey: None. D. McAllister: None. F. Mair: None.