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Bulletin of Medical Internet Conferences (ISSN 2224-6150)
2019. Volume 9. Issue 11
ID: 2019-11-8-R-19070 Краткое сообщение
Amiry E.I., Myleyeva M.N.
Frailty as a particular feature of rheumatoid arthritis
Ivanovo State Medical Academy
Abstract
Rheumatoid arthritis is a chronic, systemic inflammatory autoimmune disease leading to irreversible erosive joint destructions and damages to internal organs. It is undoubtedly true that human had suffered from this musculoskeletal disorder since ancient times. Despite the growth of treatment options of rheumatoid arthritis in recent years, a large number of patients still have a low level of life quality due to the dysfunction of various body systems. Frailty is likely to result in the decrease of activity. Today, the prevalence of frailty among patients with rheumatoid arthritis is of great interest.
Keywords: frailty, rheumatoid arthritis, sarcopenia, physical deficiency, life quality
Rheumatoid arthritis is a chronic, systemic inflammatory autoimmune disease leading to irreversible erosive joint destructions and damages to internal organs [1]. The cause of this disease is still unknown. There are some evidence to suggest that the risk of rheumatoid arthritis development is closely connected to both genetic factors and negative effect of environment, especially smoking. In industrialised countries, rheumatoid arthritis affects 0.5-2% of adults, with 5-50 per 100 000 new cases annually, the disorder being most typical in women aged 40 years and above [2]. Uncontrolled active rheumatoid arthritis causes joint pain, swelling, reduced muscule strength, resulting in impaired physical function and disability. It is undoubtedly true that human had suffered from musculoskeletal disorders since ancient times. According to archaeological sites, the first recorded evidence of inflammatory joint disease appeared after the discovery in USA of deformed Injun bones around 4500 BC. Paleonthological studies of Egyptian mummies suggested the existence of rheumatoid arthritis in Egyptians. Pain, joint swelling and loss of their function were described in the Indian Ayurveda's treatise Charak Samhita as early as 300 - 200 BC. Besides, antique physicians mentioned musculoskeletal disorders; Hippocrates described arthritis in 400 BC; Galen (129216 AD) introducing the term "rheumatismus". For a long time the term "arthritis" had used without reference to any specific form of arthritis. An English physician Thomas Sydenham identified rheumatoid arthritis as a severe form of chronic arthritis. A French doctor Londre-Beauvais in 1800 correctly established clinical picture of the rheumatoid arthritis and named it "primary asthenic gout". In 1858 A.B. Garrod, another English doctor, suggested the term "rheumatoid arthritis" instead of old terms "arthritis deformans" and "rheumatic gout". It was he who was credited of clearly separating rheumatoid arthritis from osteoarthritis and gout. Radiologic features of rheumatoid arthritis were first described by Bannatyne (1896) [3, 4]. At present time there is a tendency for intense exploration of rheumatoid arthritis. To date, there are a lot of specific scales to assess disease severity and activity (inflammation, pain, joint symptoms); moreover, the clear diagnostic criteria were also established. Extended immunological analyses revealed a close link between rheumatoid arthritis and a wide range of autoantibodies (particularly rheumatoid factor and citrullinated peptide) to significantly assist in diagnostics. The strategy of rheumatoid arthritis pharmacotherapy being developed, disease-modifying antirheumatic drugs (DMARDs) appeared to reduce synovitis and systemic inflammation improving function. Methotrexate capable of combining with other drugs of this type is the leading DMARD. Genetically engineered biological agents are a new drug group used when arthritis is uncontrolled or DMARDs cause toxic effects. Despite the growth of treatment options of rheumatoid arthritis in recent years, a large number of patients still have a low level of life quality due to the dysfunction of various body systems. Frailty is likely to result in the decrease of activity. Frailty is a multidimensional geriatric syndrome characterised by cumulative decline in multiple body systems or functions, pathogenesis involving physical as well as social dimensions [5]. Frailty definition characterized by sarcopenia, weakness, exhaustion, slowness, and low activity. It has been described as a clinical phenotype of unintentional weight loss (body mass index < 18.5), low energy, slow 4-meter walking speed (adjusted for sex and height), low physical activity, and low grip strength (adjusted for sex and BMI, measured by handheld dynamometer). The presence of 3 out of 5 of these criteria indicates frailty and the presence of 1 or 2 indicates a pre-frailty state. Individuals with no deficits were classified as robust. So, according to the study, there are three physical phenotypes of frailty: frail, pre-frail and robust [6, 7]. Frailty is also associated with decreased regenerative reserve and resistance to stressors causing to a higher risk of adverse health outcomes such as hospital admission, development of functional deficits, mortality, disability, falls and fractures. Several studies have shown a heightened inflammatory state in frail adults, and similar to other markers of frailty, gait speed has been shown to be associated with elevated levels of inflammation markers such as C-reactive protein (CRP), IL-6, and TNF-a [7]. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death [8]. Frailty is known to have similar features with sarcopenia. They are characterized by muscular failure (manifested by low grip strength, slow 4-meter walking speed, weight loss), severe fatigue, and similar methods of prevention and treatment (optimal protein intake, supplementation of vitamin D, and physical exercise) [5]. At the same time, frailty is a much broader concept than sarcopenia, the former is considered not only as a factor of physical (muscular) deficiency but a cause of inhibition of the cognitive sphere and social disadaptation. The syndrome of frailty tends to occur both in senile and younger age, more often in patients with chronic inflammatory conditions, such as rheumatoid arthritis, congestive heart failure, chronic kidney disease and chronic obstructive lung disease. Frailty is common among adults with rheumatoid arthritis. The prevalence of frailty among non-geriatric patients with rheumatoid arthritis is 13% and it is comparable to that of older geriatric cohorts. The prevalence of frailty and pre-frailty in rheumatoid arthritis cohort are greater than in a cohort of elderly patients with osteoarthritis (10% and 51%, respectively) and are comparable to patient with chronic obstructive lung disease that is on average 10 years older. The study shows, that women with rheumatoid arthritis are less likely than men to be frail while among individuals with chronic obstructive lung disease men are more likely to be frail than women. In addition, frail individuals with rheumatoid arthritis are more likely to be obese [6]. The analysis of the accumulated information shows that rheumatoid arthritis contributes greatly the development of sarcopenia, fatigue and low activity in individuals. It would seem that frailty is an important determinant of physical function in rheumatoid arthritis. Patients with rheumatoid arthritis have muscle atrophy, symptoms of fatigue and
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© Bulletin of Medical Internet Conferences, 2019
Бюллетень медицинских Интернет-конференций (ISSN 2224-6150) 2019. Том 9. № 11
decreased physical activity. We observe that frailty is likely common in rheumatoid arthritis and frail patients have a major risk for reduced physical function. Moreover, the combination of low lean mass and high fat mass is associated with frailty. Therefore, frailty is closely linked with both other geriatric syndromes and polymorbidity and it can be potentially reversible and affects the tactics of patients' management.
References
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5. Cruz-Jentoft A.J. et al. Sarcopenia: revised European consensus on definition and diagnosis // Age and Aging, 2018; 0: 1-16.
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