Frailty and reduced physical function go hand in hand in adults with rheumatoid arthritis: a US observational cohort study
- 461 Downloads
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.
KeywordsFrailty 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.
- 2.Katz PP, Radvanski DC, Allen D, Buyske S, Schiff S, Nadkarni A, Rosenblatt L, Maclean R, Hassett AL (2011) Development and validation of a short form of the valued life activities disability questionnaire for rheumatoid arthritis. Arthritis Care & Research 63(12):1664–1671. doi: 10.1002/acr.20617 CrossRefGoogle Scholar
- 3.Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research G (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156CrossRefPubMedGoogle Scholar
- 4.Cawthon PM, Marshall LM, Michael Y, Dam TT, Ensrud KE, Barrett-Connor E, Orwoll ES, Osteoporotic Fractures in Men Research G (2007) Frailty in older men: prevalence, progression, and relationship with mortality. J Am Geriatr Soc 55(8):1216–1223. doi: 10.1111/j.1532-5415.2007.01259.x CrossRefPubMedGoogle Scholar
- 5.Reeves GR, Whellan DJ, Patel MJ, O’Connor CM, Duncan P, Eggebeen JD, Morgan TM, Hewston LA, Pastva AM, Kitzman DW (2016) Comparison of frequency of frailty and severely impaired physical function in patients >/=60 years hospitalized with acute decompensated heart failure versus chronic stable heart failure with reduced and preserved left ventricular ejection fraction. Am J Cardiol. doi: 10.1016/j.amjcard.2016.03.046 Google Scholar
- 6.Roshanravan B, Khatri M, Robinson-Cohen C, Levin G, Patel KV, de Boer IH, Seliger S, Ruzinski J, Himmelfarb J, Kestenbaum B (2012) A prospective study of frailty in nephrology-referred patients with CKD. American journal of kidney diseases: the Official Journal of the National Kidney Foundation 60(6):912–921. doi: 10.1053/j.ajkd.2012.05.017 CrossRefGoogle Scholar
- 13.Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Menard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovsky J, Wolfe F, Hawker G (2010) 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62(9):2569–2581. doi: 10.1002/art.27584 CrossRefPubMedGoogle Scholar
- 18.Hewlett S, Dures E, Almeida C (2011) Measures of fatigue: Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF MDQ), Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales (BRAF NRS) for severity, effect, and coping, Chalder Fatigue Questionnaire (CFQ), Checklist Individual Strength (CIS20R and CIS8R), Fatigue Severity Scale (FSS), Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F), Multi-Dimensional Assessment of Fatigue (MAF), Multi-Dimensional Fatigue Inventory (MFI), Pediatric Quality Of Life (PedsQL) Multi-Dimensional Fatigue Scale, Profile of Fatigue (ProF), Short Form 36 Vitality Subscale (SF-36 VT), and Visual Analog Scales (VAS). Arthritis Care & Research 63(Suppl 11):S263–S286. doi: 10.1002/acr.20579 CrossRefGoogle Scholar
- 19.Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB CrossRefPubMedGoogle Scholar
- 26.Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care & Research 63(Suppl 11):S240–S252. doi: 10.1002/acr.20543 CrossRefGoogle Scholar
- 28.Castell MV, van der Pas S, Otero A, Siviero P, Dennison E, Denkinger M, Pedersen N, Sanchez-Martinez M, Queipo R, van Schoor N, Zambon S, Edwards M, Peter R, Schaap L, Deeg D (2015) Osteoarthritis and frailty in elderly individuals across six European countries: results from the European Project on OSteoArthritis (EPOSA). BMC Musculoskelet Disord 16:359. doi: 10.1186/s12891-015-0807-8 CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Johansen KL, Dalrymple LS, Delgado C, Kaysen GA, Kornak J, Grimes B, Chertow GM (2014) Association between body composition and frailty among prevalent hemodialysis patients: a US renal data system special study. Journal of the American Society of Nephrology : JASN 25(2):381–389. doi: 10.1681/ASN.2013040431 CrossRefPubMedGoogle Scholar
- 33.Garcia-Esquinas E, Jose Garcia-Garcia F, Leon-Munoz LM, Carnicero JA, Guallar-Castillon P, Gonzalez-Colaco Harmand M, Lopez-Garcia E, Alonso-Bouzon C, Rodriguez-Manas L, Rodriguez-Artalejo F (2015) Obesity, fat distribution, and risk of frailty in two population-based cohorts of older adults in Spain. Obesity 23(4):847–855. doi: 10.1002/oby.21013 CrossRefPubMedGoogle Scholar
- 34.Hirani V, Naganathan V, Blyth F, Le Couteur DG, Seibel MJ, Waite LM, Handelsman DJ, Cumming RG (2016) Longitudinal associations between body composition, sarcopenic obesity and outcomes of frailty, disability, institutionalisation and mortality in community-dwelling older men: the Concord Health and Ageing in Men Project. Age Ageing. doi: 10.1093/ageing/afw214 PubMedGoogle Scholar
- 35.Scott D, Seibel M, Cumming R, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, Waite LM, Hirani V (2016) Sarcopenic obesity and its temporal associations with changes in bone mineral density, incident falls, and fractures in older men: the concord health and ageing in men project. J Bone Miner Res Off J Am Soc Bone Miner Res. doi: 10.1002/jbmr.3016 Google Scholar