ORCID ID

0000-0002-2754-5233

Graduation Date

Summer 8-9-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Lani Zimmerman, PhD, RN

Second Advisor

Myra Schmaderer, PhD, RN

Third Advisor

Bryant England, MD, PhD

Fourth Advisor

Kaleb Michaud, PhD

MeSH Headings

rheumatology, rheumatoid arthritis

Abstract

Frailty, a physiologic vulnerability to everyday stressors, affects approximately 30% of the 1.3 million Americans with rheumatoid arthritis (RA) and is associated with increased risk for adverse health outcomes. Active RA manifests as inflammation, pain, and joint damage leading to functional impairments and morbidity which cumulatively influences frailty. However, the relationship between RA disease activity and frailty is incompletely understood.

This study evaluated the relationship of RA disease activity and frailty at baseline and over up to five years in Veterans. A cohort study was performed using data from the Veterans Affairs Rheumatoid Arthritis registry. RA disease activity was measured using Disease Activity Score in 28 joints (DAS28). Frailty was measured using 31-item VA-Frailty Index (VA-FI). Multivariable linear regression was used to evaluate the association between RA disease activity and frailty at baseline while controlling for potential confounders. The relationship of RA disease activity with frailty was assessed longitudinally using generalized estimation equations over five years.

Of the 2,800 Veterans studied, mean was age 64 years, average RA disease duration 12 years, most were males (89%), White (76%), had smoking history (79%), and 28% were frail. In the adjusted model at baseline, higher DAS28 (aß 0.009, 95% CI 0.006-0.011) and components of RA disease activity including patient global (aß 0.058, 95% CI 0.044-0.072), provider global (aß 0.031, 95% CI 0.015-0.048), tender joint count (aß 0.009, 95% CI 0.003-0.014, p=0.001), erythrocyte sedimentation rate (aß 0.065, 95% CI 0.050-0.081), and C-reactive protein (aß 0.028, 95% CI 0.016-0.039) (all other p-values

Higher RA disease activity in Veterans predicted higher VA-FI over up to five years. Patient global assessment was an important contributor. Future studies should assess whether achieving low disease activity or remission and provision of multidisciplinary care can decrease frailty burden in Veterans with RA.

Comments

Fifth Advisor: Katherine Wysham, MD

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