Journal Article

POS1028 FRAILTY IS ASSOCIATED WITH A LACK OF OPPORTUNITIES FOR VOCALIZATION IN RHEUMATOID ARTHRITIS PATIENTS

Sobue, Y., Suzuki, M., Imagama, S., Asai, S., Ohashi, Y., Ishikawa, H.

2024

Overview

Background:A lack of opportunities for vocalization can lead to a decline in vocal cord function, and oral function, as well as cognitive function, and a reduction in social connections. Consequently, oral, cognitive, and social frailty are expected to increase. When oral function declines, the amount of food intake decreases, potentially resulting in weight loss (one of the CHS criteria for frailty) and muscle mass loss (sarcopenia). Indeed, it was reported that the elderly people with declining oral function were at a higher risk of developing physical frailty, sarcopenia, nursing care requirements, and even death, compared with those without such decline [1]. On the other hand, rheumatoid arthritis (RA) is one of the causative diseases for frailty [2].Objectives:In this study, we investigated the association between frailty and vocalization in RA patients.Methods:Among 696 RA patients visited in 2023, 661 patients were available for the investigation of patient backgrounds, including Clinical Disease Activity Index (CDAI) and the Kihon Checklist (KCL), which was an evaluation method for frailty, and their responses to a questionnaire regarding vocalization. Frequency of vocalization was categorized into four levels: “every day”, “1-5 times a week”, “1-3 times a month”, and “almost never”. Frailty was defined as a KCL score of 8 points or higher. Odds ratios associated with frailty were calculated using multivariable logistic regression analysis.Results:Among 661 RA patients (474 women, 71.8%), 261 (39.5%) patients exhibited frailty. The mean age (± standard deviation) was 73.6 ± 11.9/65.2 ± 13.5 years (frailty group/non-frailty group), disease duration was 14.7 ± 10.8/11.4 ± 9.2 years, and CDAI was 9.1 ± 9.2/4.5 ± 5.9, both of which were higher significantly in the frailty group. The proportion of methotrexate (MTX) use was 68.8/48.3%, which were higher significantly in the non-frailty group. Frequency of vocalization (“every day”/“1-5 times a week”/“1-3 times a month”/“almost never”) was 37.2%/25.7%/11.1%/26.1% in the frailty group and 62.5%/20.5%/7.8%/9.2% in the non-frailty group, and frequency of vocalization was lower in the frailty group. Factors significantly associated with frailty were age (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.04-1.08), MTX use (OR 0.63, 95%CI 0.41-0.94), CDAI (OR 1.10, 95%CI 1.07-1.13) and “infrequent vocalization (1-3 times a month, almost never)” (OR 2.67, 95%CI 1.75-4.08).Conclusion:In this study, frailty was significantly associated with a lack of opportunities for vocalization, as well as disease activity in RA patients. For patients, oral, cognitive, and social frailty are difficult to recognize. These results suggest that encouraging the recognition of vocalization and supporting patients in vocalizing may be beneficial in preventing frailty.REFERENCES:[1] Tanaka T, et al. Oral Frailty as a Risk Factor for Physical Frailty and Mortality in Community-Dwelling Elderly. J Gerontol A Biol Sci Med Sci. 2018;73:1661-1667.[2] Sobue Y, et al. Relationship between locomotive syndrome and frailty in rheumatoid arthritis patients by locomotive syndrome stage. Mod Rheumatol. 2021;32:546-53.Table 1.Demographics and clinical characteristics of subjectsVariablesFrailty (n=261)Non-frailty (n=400)p valueAge (years)Mean (SD)73.6 (11.9)65.2 (13.5)<0.001*Duration of disease (years)Mean (SD)14.7 (10.8)11.4 (9.2)<0.001*Sex, female (%)70.172.90.479BMI (kg/m2)Mean (SD)22.2 (4.1)22.1 (3.5)0.607Married (%)57.868.50.006*Steinbrocker stage (3/4) (%)48.531.2<0.001*Rheumatoid factor positive (%)69.963.00.077Glucocorticoid use (%)36.822.5<0.001*Methotrexate use (%)48.368.8<0.001*bDMARD use (%)3332.81.000tsDMARD use (%)14.26.50.002*CDAIMean (SD)9.1 (9.2)4.5 (5.9)<0.001*Frequency of vocalization(“every day”/“1-5 times a week”/“1-3 times a month”/“almost never”) (%)37.2/25.7/11.1/26.162.5/20.5/7.8/9.2<0.001*Frailty, The Kihon Checklist (KCL) ≥8 points; BMI, body mass index; bDMARD, biological disease-modifying antirheumatic drug; tsDMARD, targeted synthetic DMARD; CDAI, Clinical Disease Activity Index; SD, standard deviation. *p<0.05.Acknowledgements:NIL.Disclosure of Interests:None declared.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Age / Body mass index / Body weight loss / Check lists / Cognitive ability / Disease / Epidemiology / Food intake / Frailty / Lifestyles / Methotrexate / Observational studies/ registry / Older people / Patient Reported Outcome Measures / Rheumatoid arthritis / Rheumatoid factor / Risk factors / Sarcopenia / Scientific Abstracts / Social interactions / Standard deviation / Vocalization behavior