Prevalence of Frailty Compared Between Patients With Ankylosing Spondylitis, Psoriatic Arthritis, and Rheumatoid Arthritis

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Researchers determined and compared the prevalence of frailty between patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

Patients aged 65 years and older with rheumatoid arthritis (RA) are more likely than those with ankylosing spondylitis (AS) or psoriatic arthritis (PsA) to have frailty and are more likely to have frailty than those aged younger than 65 years, according to study results published in ACR Open Rheumatology.

Researchers determined the prevalence of frailty among patients with RA, AS, and PsA and compared the characteristics associated with frailty between these 3 types of inflammatory arthritis.

The cross-sectional study included 59,087 individuals aged younger than 65 years (AS, n=2490; PsA, n=6950; RA, n=49,647) and 238,090 individuals aged 65 years and older (AS, n=2750; PsA, n=17,779; RA, n=217,561), all of whom were beneficiaries of the Centers for Medicare & Medicaid Services (CMS) enrolled in 2014. A validated claims-based frailty index (CFI) was used to assess frailty. Patients aged younger than 65 years with a work disability were also examined, given that this population may be at risk for frailty.

Frailty was common among patients with RA, PsA, and AS; however, among patients aged 65 years and older, the prevalence of frailty was significantly higher in those with RA (65.9%) than those with AS (45.2%) and PsA (46.7%; P <.05). Similarly, among patients aged younger than 65 years, the presence of frailty was higher among those with RA (11.7%) compared with those with AS (4.4%) and PsA (7.0%; P <.05).

The researchers noted a significant association between anxiety and frailty vs nonfrailty among participants of all ages, but specifically among those aged younger than 65 years (39.5% vs 19.8% among those with AS, 41.5% vs 27.5% among those with PsA, and 37.4% vs 22.1% among those with RA [P <.05 for all]).

Study limitations included the inability to directly validate the CFI against the Fried frailty phenotype, uncertainty around the best frailty construct for patients with inflammatory arthritis, the inability to address the effect of medication use or disease activity, the potential for higher apparent levels of anxiety among those using the CFI, potential misclassification, and the risk for age to affect frailty prevalence in the study’s age groups.

The study researchers concluded that “patients with AS or PsA were less likely to be frail than those with RA.” They also noted that ” patients [with frailty] with AS and PsA could have similar increased risk [for] death, time to death, number of hospital admissions, and number of nursing home admissions as other frail Medicare enrollees [aged] 65 years [and] older.”

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Lieber SB, Navarro-Millán I, Rajan M, et al. Prevalence of frailty in ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis: data from a national claims dataset. ACR Open Rheumatol. Published online January 5, 2022. doi:10.1002/acr2.11388