Frailty in rheumatoid arthritis and the general population: A cross-sectional analysis of the Groningen Frailty Indicator and Fried criteria

Abstract Objective To compare frailty prevalence and factors driving frailty between older adults with rheumatoid arthritis (RA) and controls, using two conceptually distinct frailty instruments. Methods Cross-sectional data from the STudying Ageing in Rheumatoid arthritis (STAR) study were used, including 207 patients with RA and 214 population controls aged 55-85 years. Frailty was assessed using the Groningen Frailty Indicator (GFI; 15 yes/no items; physical, cognitive, social, psychological domains; frail≥4/15) in all participants and the Fried criteria (5 yes/no items; physical domain; prefrail=1-2, frail≥3, and combined frail/prefrail≥1 deficit) in a clinically assessed subgroup (RA: n = 88, controls: n = 96). Prevalence and overlap between instruments were described by group. Uni- and multivariable logistic (GFI: frailty vs. robust) and Poisson (Fried: frail/prefrail vs. robust) regressions assessed effects of age, group, the age*group interaction, and additional covariates. Results Frailty prevalence was higher in RA than controls for GFI-frailty (34% vs 18%) and Fried-frailty/prefrailty (72% vs 50%). Among GFI-frail persons, 88% of patients with RA compared to 69% of controls were also frail or prefrail by Fried. Age was not associated with frailty in uni- or multivariable analyses for either instrument, in RA or controls (p interaction age*group>0.10). The association with RA became insignificant after multivariable adjustment. Living alone, comorbidity score ≥1, higher fatigue, and anxiety were associated with GFI-frailty, and higher BMI and poorer physical function with Fried- frailty/prefrailty. Conclusion 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.