Well‐controlled disease activity with drug treatment will not improve the frailty status of RA patients to robust state: A multicenter observational study (T‐FLAG)

Abstract

AbstractObjectivesTo investigate a plateau in treatment enhancement for improving the frailty status of rheumatoid arthritis (RA) patients.MethodsA total of 345 RA patients who were not robust in 2021 were assigned to the improved (“robust 2022,” n = 51) and non‐improved (“pre‐frailty/frailty 2022,” n = 294) groups. Factors associated with “robust 2022” were examined by logistic regression analysis. Patients were assigned to the stable (Follow‐up mean DAS28‐ESR in 2020 and 2021 < 3.2, n = 225) and unstable (≥3.2, n = 120) groups, which were further divided into the non‐improved (stable: n = 180, unstable: n = 114) and improved (stable: n = 45, unstable: n = 6) groups. Factors influencing Japanese Cardiovascular Health Study (J‐CHS) score were examined by multiple regression analysis. Changes over 2 years were compared between the non‐improved and improved groups of the stable group.ResultsThe associated factor of “robust 2022” was the follow‐up meanDAS28‐ESR in 2020 and 2021 < 3.2 (i.e., stable state) (OR: 4.01). Follow‐up mean DAS28‐ESR in 2020 and 2021 was associated with J‐CHS score (T = 2.536, p = .013) only in the unstable group. In the stable group, HAQ‐DI was lower (2020: 0.32 vs. 0.16; 2021: 0.32 vs. 0.17; 2022: 0.32 vs. 0.21), and the proportion of J‐CHS: Q4 (weakness) was lower (2020: 48.4 vs. 17.8%; 2021: 55.0 vs. 29.2%; 2022: 50.4 vs. 0%), in the improved group than in the non‐improved group, whereas both groups maintained clinical and functional remission over 2 years.ConclusionsDrug treatment to maintain well‐controlled disease activity alone is insufficient for improving patients' frailty status after achieving treat‐to‐target goals, suggesting the need for multifaceted approaches.