Состояние старческой астении у пациентов с ревматоидным артритом связано с сопутствующими заболеваниями, а не с возрастом

Older adults with rheumatoid arthritis (RA) are more likely to meet criteria for frailty or prefrailty than adults without RA, although clinical and psychosocial factors may account for much of this difference, according to study results published in Rheumatology. Frailty is associated with reduced physiologic reserve and an increased risk for adverse outcomes, including disability, falls, hospitalization, and mortality. However, evaluating frailty in RA can be difficult because characteristics such as fatigue, weakness, and impaired physical function can reflect either frailty or manifestations of the underlying rheumatic disease. Researchers conducted a cross-sectional analysis of the Studying Ageing in Rheumatoid Arthritis (STAR) study to compare frailty between patients with RA and population controls and identify factors associated with frailty in each group. Participants were aged 55 to 85 years and were recruited between December 2022 and April 2025. Frailty was assessed with the Groningen Frailty Indicator (GFI) in the full cohort. The 15-item questionnaire evaluates physical, cognitive, social, and psychological domains, with scores of 4 or higher indicating frailty. A subset of participants also completed a clinical assessment using the Fried criteria, which encompass unintentional weight loss, exhaustion, low physical activity, slow gait speed, and low handgrip strength. Participants meeting 1 or 2 Fried criteria were considered prefrail, and those meeting at least 3 were considered frail. Older adults with RA show higher (pre)frailty prevalence than controls, which is associated with disease-related consequences and vulnerability rather than age, questioning the added value of frailty assessment beyond routine clinical evaluation. The study included 207 patients with RA and 214 population control participants. Mean age was 67.8±7.3 years among patients with RA and 68.1±7.1 years among control participants; women represented 62% and 60% of each group, respectively. Patients with RA were more likely than control participants to have low or middle educational attainment (57% vs 41%), be current smokers (15% vs 6%), and have a Charlson Comorbidity Index score of at least 1 (43% vs 30%). The clinical assessment subgroup included 88 patients with RA and 96 control participants. On the GFI, frailty was identified in 34% of patients with RA compared with 18% of control participants. Differences were also observed using the Fried criteria: Among clinically assessed participants, 65% of patients with RA were prefrail and 7% were frail, compared with 45% and 5% of control participants, respectively. Overall, 72% of patients with RA met criteria for either prefrailty or frailty compared with 50% of control participants. Several individual frailty components differed between groups. Among participants classified as frail by the GFI, patients with RA more frequently reported poor physical fitness than control participants (69% vs 47%) and were more likely to have polypharmacy (80% vs 39%). Among those meeting Fried criteria for prefrailty or frailty, unintentional weight loss was more common in the RA group (21% vs 6%). Exhaustion and low handgrip strength were among the most common Fried components in both groups. Classification also varied by frailty instrument. Of patients with RA who were considered frail according to the GFI, 88% were also identified as prefrail or frail by the Fried criteria. In contrast, only 36% of patients with RA who met Fried criteria for prefrailty or frailty were classified as frail by the GFI. RA was associated with both GFI-defined frailty and Fried-defined frailty/prefrailty before adjustment. However, the associations were attenuated after accounting for relevant clinical and sociodemographic variables. In multivariable analyses, RA was not independently associated with GFI-defined frailty (odds ratio [OR], 0.97; 95% CI, 0.52-1.82) or Fried-defined frailty/prefrailty (prevalence ratio [PR], 1.13; 95% CI, 0.91-1.40). Age also was not significantly associated with frailty according to either assessment. Instead, GFI-defined frailty was associated with living alone (OR, 2.61; 95% CI, 1.34-5.07), having at least 1 comorbidity (OR, 1.95; 95% CI, 1.05-3.62), greater fatigue (OR, 1.04; 95% CI, 1.02-1.07), and mild to severe anxiety (OR, 4.07; 95% CI, 1.95-8.49). Fried-defined prefrailty or frailty was associated with higher body mass index (PR, 1.02; 95% CI, 1.01-1.03) and greater impairment on the Health Assessment Questionnaire Disability Index (PR, 1.40; 95% CI, 1.13-1.73). In a sensitivity analysis that incorporated additional patients with RA aged 70 years and older, the prevalence of Fried-defined frailty increased from 7% to 16%. Although age was initially associated with Fried-defined prefrailty/frailty in this expanded analysis, the association was no longer present after adjustment. Limitations included the cross-sectional design, which prevented assessment of frailty progression or causal relationships, potential selection bias, and limited generalizability. “Older adults with RA show higher (pre)frailty prevalence than controls, which is associated with disease-related consequences and vulnerability rather than age, questioning the added value of frailty assessment beyond routine clinical evaluation,” the researchers concluded. “Further longitudinal analyses are needed to understand the performance of different frailty instruments.” This research was supported by Pfizer and the Dutch Arthritis Society. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. This article originally appeared on Rheumatology Advisor