Frailty in the Rheumatology Clinic: Current Approaches to Assessment and Management

Abstract

To illustrate frailty in the context of rheumatic disease, we will consider two women, both 65 years of age who have been living with rheumatoid arthritis (RA) for the past 15 years.

Case #1: Rita is a retired lawyer. Her RA has been well-controlled, having remained in remission for the past 5 years on a combination of low‑dose methotrexate and a tumour necrosis factor (TNF) inhibitor. She is otherwise healthy, with no comorbid medical conditions and no additional prescription medications. She lives independently with her husband and enjoys attending group fitness classes at the recreation centre in her neighbourhood.

Case #2: Alice lives alone in a rural area. She previously worked as a waitress but has been unable to work for the past 10 years due to chronic mechanical low back pain. Her RA has led to significant joint damage and remains moderately active despite treatment with hydroxychloroquine, sulfasalazine, and chronic low-dose prednisone. She also has a history of diabetes, heart failure, and depression, for which she takes six additional medications. Following a couple of falls last year, she now uses a walker at home. Alice has difficulty leaving the house due to poor mobility along with poor vision. Her neighbour helps with groceries and medical appointments.

Although these two women are chronologically identical in age, their health trajectories and risks for adverse outcomes differ substantially. Frailty provides a framework for understanding this heterogeneity.