Clinical Rheumatology

, Volume 36, Issue 5, pp 1031–1039 | Cite as

Frailty and reduced physical function go hand in hand in adults with rheumatoid arthritis: a US observational cohort study

  • James S. Andrews
  • Laura Trupin
  • Edward H. Yelin
  • Catherine L. Hough
  • Kenneth E. Covinsky
  • Patricia P. Katz
Original Article


Reduced physical function and health-related quality of life are common in rheumatoid arthritis (RA), and further studies are needed that examine novel determinates of reduced physical function in RA. This study examines whether frailty, a state of increased vulnerability to stressors, is associated with differences in self-reported physical function among adults with RA. Adults from a longitudinal RA cohort (n = 124) participated in the study. Using an established definition of frailty, individuals with three or more of the following physical deficits were classified as frail: (1) body mass index ≤18.5, (2) low grip strength (adjusted for sex and body mass index (BMI), measured by handheld dynamometer), (3) severe fatigue (measured by the Multidimensional Assessment of Fatigue), (4) slow 4-m walking speed (adjusted for sex and height), and (5) low physical activity (measured by the International Physical Activity Questionnaire). Individuals with one or two deficits were classified as “pre-frail” and those with no deficits as “robust.” Self-reported physical function was assessed by the Health Assessment Questionnaire (HAQ) and the Valued Life Activities Difficulty scale. Regression analyses modeled associations of frailty category with HAQ and Valued Life Activities (VLA) Difficulty scores with and without controlling for age, sex, disease duration, C-reactive protein, use of oral steroids, and pain. Among adults with RA, being frail compared to being robust was associated with a 0.44 worse VLA score (p < 0.01) when the effects of covariates are held constant. Being frail, compared to being robust, is associated with clinically meaningful differences in self-reported physical function among adults with RA.


Frailty Patient-reported outcomes Physical disability Rheumatoid arthritis 



The authors would like to thank all the patients whose participation made this study possible.

Compliance with ethical standards

The study was approved by the UCSF IRB, Committee on Human Research, approval no. 11-05702.




This research was supported by NIH/NIAMS grant P60 AR053308 and by NIH/NCRR UCSF-CTSI grant number UL1 RR024131 and by the Russell/Engleman Rheumatology Research Center.


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2017

Authors and Affiliations

  • James S. Andrews
    • 1
  • Laura Trupin
    • 2
  • Edward H. Yelin
    • 2
  • Catherine L. Hough
    • 3
  • Kenneth E. Covinsky
    • 4
  • Patricia P. Katz
    • 2
  1. 1.Division of RheumatologyUniversity of WashingtonSeattleUSA
  2. 2.Division of RheumatologyUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Division of Pulmonary and Critical Care MedicineUniversity of WashingtonSeattleUSA
  4. 4.Division of GeriatricsUniversity of California San FranciscoSan FranciscoUSA

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