Longitudinal Frailty Status in Rheumatoid Arthritis and Its Association With Disease Activity and Glucocorticoid Use

OBJECTIVE: To examine factors associated with a higher long-term frailty status in patients with rheumatoid arthritis (RA). METHODS: We analyzed 313 patients who had complete annual Japanese version of the Cardiovascular Health Study (J-CHS) assessments from 2020 to 2025. Frailty status was evaluated using the mean J-CHS score across the study period, and patients were classified into two groups: mean J-CHS ≤ 2 (n = 236) and mean J-CHS > 2 (n = 77). Factors associated with mean J-CHS > 2 were examined using logistic regression analysis. RESULTS: Compared to patients with mean J-CHS ≤ 2, those with mean J-CHS > 2 were older (63.9 vs. 68.2 years) and had a longer disease duration (9.8 vs. 15.1 years), higher disease activity (mean DAS28-ESR: 2.44 vs. 3.17), higher rate of glucocorticoid use (23.3% vs. 36.4%), and worse physical function (mean HAQ-DI: 0.21 vs. 0.77). Logistic regression analysis identified longer disease duration (OR 1.06), higher DAS28-ESR (OR 2.38), and glucocorticoid use (OR 2.90) as independent factors associated with mean J-CHS > 2. In longitudinal analyses, patients with higher frailty status consistently exhibited higher glucocorticoid use over time. Among patients who achieved baseline remission, disease activity remained comparable between groups, whereas glucocorticoid use remained consistently higher in patients with mean J-CHS > 2. CONCLUSIONS: Long-term frailty status in RA was associated with disease duration and treatment patterns, particularly continued glucocorticoid exposure. Even among patients in remission, those with mean J-CHS > 2 showed persistently higher glucocorticoid use despite comparable disease activity, without corresponding DMARD intensification, which may reflect differences in treatment patterns in this subgroup.