Ab0572 Neglecting Mental Health in Rheumatoid Arthritis Patients Leads to Progression Into Frailty

Background: Frailty, a term used to describe the health condition of the elderly, usually involves a decline of physical function (1). In Japan, with its rapidly aging population demographic, frailty is becoming a serious social problem and is especially prevalent in those with poorly controlled rheumatoid arthritis (RA), an autoimmune disease that causes joint synovitis, leading to destruction of the joints and weakening of the surrounding muscles. While frailty originally tended to be associated with a decline in physical function, it is now realized that those with frailty often also have mental, social, cognitive, and nutritional problems. Accordingly, there is now a growing interest in other areas of frailty (2). Objectives: This study focuses on various types of frailty and examines predictive factors for frailty in RA patients. Methods: Frailty was diagnosed by means of the Kihon Checklist (KCL), which assesses frailty on the basis of seven categories: general living functions, physical activity, nutritional status, oral function, social withdrawal, cognitive function, and mental health disorders (3) (Figure 1). Patients with a KCL score of 3 or less were diagnosed with non-rheumatic frailty; those with a score of 4 or more were diagnosed with rheumatic frailty. Of 683 patients attending RA outpatient clinics at three institutions, 510 RA patients for whom KCL data were recorded from 2021 to 2023 were included in the study, and a further 376 rheumatic frailty patients in 2021 were examined as baseline data. In the 2023 cohort, patients were separated into a non-rheumatic frailty group (n = 61) and a rheumatic frailty group (n = 315). After comparing patient characteristics, we used logistic regression analysis to examine predictive factors of rheumatic frailty for each of the seven KCL categories in RA patients. In addition, the relationship between mental health problems and frailty was examined based on predictive factors of frailty. Results: Comparison of the rheumatic frailty group with the non-rheumatic frailty group in terms of median values yielded the following results: the rheumatic frailty group was older (69.2 yrs. vs. 61.5 yrs.) and had a longer disease duration (12.9 yrs. vs. 10.0 yrs.), higher Steinbrocker class, and higher KCL scores (cat 1: 1.9 vs. 1.4; cat 2: 2.3 vs. 1.3; cat 4: 1.1 vs. 0.5; and cat 7: 1.9 vs. 0.9). Among each KCL category, only mental health was a significant predictor of frailty progression (OR: 95%; CI: 1.57, 1.22–2.02). Age (1.04, 1.02–1.07) and HAQ-DI (7.15, 2.55–20.10) were other predictors. The greater the number of KCL items related to mental health disorders, the more likely a patient was to develop rheumatic frailty two years later (Figure 2A). Patients with mental health disorders at baseline, when compared to those having normal mental health, had significant problems in other KCL categories two years later, thus: general living functions (1.8 vs. 1.4), physical activity (2.6 vs. 2.2), oral function (1.4 vs. 0.9), social withdrawal (0.6 vs. 0.3), and mental health condition (2.5 vs. 1.1) (Figures 2B, C, E, F, and H). Conclusion: Mental health is an essential predictor of frailty progression. Neglecting mental health care may lead not only to the progression of frailty but also to other problems. REFERENCES: 1 Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752-62. 2 Öztorun HS, Gözükara B, Bahşi R, Turgut T, Sürmeli DM, Seçer Ç C, et al. Association between depression scores and comprehensive geriatric assessment and frailty in geriatric outpatients with somatic complaints: an observational cross-sectional study. Turk J Med Sci. 2022;52(3):715-23. 3 Fukutomi E, Okumiya K, Wada T, Sakamoto R, Ishimoto Y, Kimura Y, et al. Importance of cognitive assessment as part of the "Kihon Checklist" developed by the Japanese Ministry of Health, Labor and Welfare for prediction of frailty at a 2-year follow up. Geriatr Gerontol Int. 2013;13(3):654-62. Acknowledgements: We gratefully acknowledge the work of past and present members of the Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan and Aich medical University, Nagakute, Japan. Disclosure of Interests: None declared.