Frailty in people with rheumatoid arthritis: a systematic review of observational studies

Hanlon, P. , Morrison, H., Morton, F., Jani, B. D. , Siebert, S. , Lewsey, J. , McAllister, D. and Mair, F. S. (2021) Frailty in people with rheumatoid arthritis: a systematic review of observational studies. Wellcome Open Research, 6, 244. (doi: 10.12688/wellcomeopenres.17208.1)

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Abstract

Background: Frailty, an age-related decline in physiological reserve, is an increasingly important concept in the management of chronic diseases. The implications of frailty in people with rheumatoid arthritis are not well understood. We undertook a systematic review to assess the prevalence of frailty in people with rheumatoid arthritis, and the relationship between frailty and clinical outcomes. Methods: We searched three electronic databases (January 2001 to April 2021) for observational studies assessing the prevalence of frailty in adults (≥18 years) with rheumatoid arthritis, or analysing the relationship between frailty and clinical outcomes in the context of rheumatoid arthritis. Titles, abstracts and full texts were assessed independently by two reviewers. Study quality was assessed using an adapted Newcastle-Ottawa Scale. Results: We identified 17 analyses, from 14 different sample populations. 15/17 were cross-sectional. These studies used 11 different measures of frailty. Frailty prevalence ranged from 10% (frailty phenotype) to 36% (comprehensive rheumatologic assessment of frailty) in general adult populations with rheumatoid arthritis. In younger populations (<60 or <65 years) prevalence ranged from 2.4% (frailty phenotype) to 19.9% (Kihon checklist) while in older populations (>60 or >65) prevalence ranged from 31.2% (Kihon checklist) to 55% (Geriatric 8 tool). Frailty was associated with higher disease activity (10/10 studies), lower physical function (7/7 studies), longer disease duration (2/5 studies), hospitalization (1/1 study) and osteoporotic fractures (1/1 study). Conclusion: Our review found that frailty is common in adults with rheumatoid arthritis, including those aged <65 years, and is associated with a range of adverse features. However, these is substantial heterogeneity in how frailty is measured in rheumatoid arthritis. We found a lack of longitudinal studies making the impact of frailty on clinical outcomes over time and the extent to which frailty is caused by rheumatoid arthritis unclear.

Item Type:Articles
Additional Information:Version 1; peer review: 1 approved with reservations.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Jani, Dr Bhautesh and McAllister, Professor David and Morrison, Dr Holly and Hanlon, Dr Peter and Lewsey, Professor Jim and Siebert, Professor Stefan and Mair, Professor Frances and Morton, Mr Fraser
Creator Roles:
Hanlon, P.Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Visualization, Writing – original draft, Writing – review and editing
Morrison, H.Investigation, Writing – review and editing
Morton, F.Writing – review and editing
Jani, B. D.Writing – review and editing
Siebert, S.Writing – review and editing
Lewsey, J.Conceptualization, Investigation, Methodology, Supervision, Writing – review and editing
McAllister, D.Conceptualization, Investigation, Methodology, Supervision, Writing – review and editing
Mair, F. S.Conceptualization, Investigation, Methodology, Supervision, Writing – review and editing
Authors: Hanlon, P., Morrison, H., Morton, F., Jani, B. D., Siebert, S., Lewsey, J., McAllister, D., and Mair, F. S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Wellcome Open Research
Publisher:F1000Research
ISSN:2398-502X
ISSN (Online):2398-502X
Copyright Holders:Copyright © 2021 Hanlon P et al.
First Published:First published in Wellcome Open Research 6: 244
Publisher Policy:Reproduced under a Creative Commons License
Data DOI:10.5281/zenodo.5515860

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
173492Combining efficacy estimates from clinical trials with the natural history obtained from large routine healthcare databases to determine net overall treatment benefitsDavid McAllisterWellcome Trust (WELLCOTR)201492/Z/16/ZInstitute of Health & Wellbeing
305232Understanding prevalence and impact of frailty in chronic illness and implications for clinical managementFrances MairMedical Research Council (MRC)MR/S021949/1HW - General Practice and Primary Care