Frailty Common Among Patients With Rheumatoid Arthritis

More than one-third of patients with rheumatoid arthritis (RA) met criteria for frailty in a Japanese study, with functional disability and lack of exercise emerging as key drivers of vulnerability.1

Published in Progress in Rehabilitation Medicine, the findings highlight the importance of managing physical function and promoting activity to reduce long-term care needs among this patient population.

In the cross-sectional study, researchers assessed 626 patients with RA using the Kihon Checklist (KCL), a validated tool developed by Japan’s Ministry of Health, Labour, and Welfare to screen for individuals at risk of needing long-term care. Patients were categorized based on their KCL scores: robust (score 0-3), prefrailty (score 4-7), or frailty (score ≥8).

Overall, 36.9% of participants were classified as having frailty, 30.5% with prefrailty, and 32.6% as robust.

Age and Functional Disability Drive Frailty Risk

Frailty prevalence increased steeply with age. Only 18.4% of patients 64 years or younger had frailty, compared with 64.7% of those aged 80 to 84 years and 81.8% of those 85 years or older. Researchers noted that patients with both RA and frailty were generally older with more functional disability and weren’t exercising regularly. Patients with RA and prefrailty were also older with greater functional disabilities.

Multivariate analysis identified age, higher Health Assessment Questionnaire Disability Index (HAQ-DI) scores, and lack of habitual exercise as the most significant predictors of frailty when compared with robust patients. HAQ-DI, a widely used measure of physical function in RA, showed the strongest correlation with KCL scores across multiple domains, including activities of daily living and mood.

Prevalence Higher Than General Population

Frailty is linked to higher risks of hospitalization, falls, and disability. | Image credit: Masakazu Tokashiki – stock.adobe.com

The study noted that frailty is more common in RA compared with the general older population. Prior systematic reviews estimated frailty prevalence at 17.2% among community-dwelling older adults, whereas the current analysis found a 36.9% prevalence in RA.

“We believe that patients with RA have high risk of requiring a long-term care in the future,” the researchers noted. “To avoid long-term care for patients with RA, factors associated with frailty must be improved.”

The authors emphasized the importance of exercise in mitigating risk, as it can reduce inflammation and oxidative stress while supporting muscle mass and strength.2 Previous trials have shown that aerobic, resistance, and balance training can reverse frailty or delay its onset in older adults.3 In this RA cohort, regular exercise was protective against frailty, and patients who reported exercising at least twice weekly had significantly better outcomes.1

“Maintaining physical function is important because 10 points of the KCL score are assessed with activities of daily living and physical functions,” the researchers said. “We believe that engaging in exercise to maintain a low HAQ-DI may prevent frailty.”

Managed Care Implications

The high prevalence of frailty among patients with RA has important implications for managed care. Frailty is strongly associated with higher risks of hospitalization, falls, disability, and the need for long-term care services. In this study, prefrailty and frailty were associated with a 2-fold to nearly 5-fold increased risk of requiring long-term care within 3 years, based on prior validation of the KCL in older adults.

These findings echo prior research showing that frailty directly impairs treatment outcomes in RA. A prospective study using the Comprehensive Rheumatologic Assessment of Frailty showed that frailty significantly reduced the likelihood of patients achieving comprehensive disease control while on biologic therapy.4 Together, these studies suggest frailty is not only common among individuals with RA but also influences both functional status and therapeutic response. Recognizing and addressing frailty through exercise, pain management, and structured assessments may therefore be essential to improving long-term outcomes for this population.

The researchers noted their study population skewed older and had relatively well-controlled disease activity, which may limit generalizability.1 As a cross-sectional study, the analysis could not determine causality between RA-related disability and frailty development.

“However, we believe that our results will contribute to the efforts to address this issue in daily clinical practice,” the authors said. “A prospective longitudinal study with various variables is required to clarify this relationship.”

References

1. Mochizuki T, Yano K, Ikari K, Okazaki K. Relationship between frailty assessed using the Kihon checklist and rheumatoid arthritis. Prog Rehabil Med. 2025;10:20250023. doi:10.2490/prm.20250023
2. Angulo J, El Assar M, Álvarez-Bustos A, Rodríguez-Mañas L. Physical activity and exercise: strategies to manage frailty. Redox Biol. 2020;35:101513. doi:10.1016/j.redox.2020.101513
3. Sadjapong U, Yodkeeree S, Sungkarat S, Siviroj P. Multicomponent exercise program reduces frailty and inflammatory biomarkers and improves physical performance in community-dwelling older adults: a randomized controlled trial. Int J Environ Res Public Health. 2020;17(11):3760. doi:10.3390/ijerph17113760
4. Klein HE. Frailty lowers likelihood of achieving comprehensive disease control in RA, study finds. AJMC®. January 14, 2022. Accessed September 19, 2025. https://www.ajmc.com/view/frailty-lowers-likelihood-of-achieving-comprehensive-disease-control-in-ra-study-finds