THU0612-HPR DOES PAIN AND COMORBIDITY BURDEN PREDICT FRAILTY IN PATIENTS WITH KNEE-OSTEOARTHRITIS? FINDINGS FROM THE RESEARCH ON OSTEOARTHRITIS AGAINST FRAILTY (ROAF) STUDY.
Authors: F. Salaffi, M. Carotti, S. Farah, M. DI Carlo, A. Giovagnoni
Journal: Annals of the Rheumatic Diseases (2020)

Background: Pain and comorbidity burden has been suggested to act as a stressor during aging, potentially accelerating declines in health and functioning in patients with osteoarthritis of the knee (KNEE-OA) (1,2). Objectives: The aims of the present research were to assess (i ) the prevalence of frailty and (ii ) its potential associated factors in a cohort of adult patients with KNEE-OA. Methods: Patients fulfilling the clinical American College of Rheumatology knee-OA criteria were assessed according to the Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI), and classified as frail, pre-frail, or non-frail. The clinical evaluation included the following items: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain subscale (3) and Medical Outcomes Study Short Form-36 (SF-36). Evaluation of the comorbidities burden was performed with the modified Rheumatic Disease Comorbidity Index (mRDCI). Radiographic knee OA was defined according to Kellgren/Lawrence (KL) grades. Chi-square, analysis of variance (ANOVA), and multinomial logistic regression analyses were used to test the prognostic value of frailty for the outcomes of interest. Table 1. Multinomial logistic regression analyses:c oefficients, standard errors and Wald statistic. Variable Coefficient Std. Error Wald P Age, yrs -0.17872 0.065399 4.4682 0.0534 Gender -0.087304 0.73366 0.01416 0.9053 BMI, Kg/m 2 -0.096320 0.081124 1.4097 0.2351 Pain duration from diagnosis, yrs 0.13065 0.069051 3.5801 0.0585 Educational level, yrs 0.066913 0.080301 0.6944 0.4047 Kellgren/Lawrence grades 0.62074 0.50629 1.5032 0.2202 mRDCI -0.60277 0.18993 10.0714 0.0015 SF36-MCS 0.028143 0.020074 1.9655 0.1609 SF36-PCS -0.00070260 0.025118 0.0007824 0.9777 WOMAC Pain subscale -0.29129 0.081619 12.7373 0.0004 Constant 17.42518 5.73269 9.2393 0.0024 Figure 1. Distribution of the WOMAC-Pain scores according to the frailty categories by SHARE-FI, and p-values for comparison (ANOVA test) Conclusion: Frailty or pre-frailty are common in KNEE-OA. The main factors associated with frailty were pain and comorbidity burden. Implementation of the frailty assessment into the routine rheumatological practice could represent a major advance in KNEE-OA care. Further studies are needed to identify the physiological mechanisms underpinning these associations. References: [1]Veronese N, Maggi S, Trevisan C, Noale M, De Rui M, Bolzetta F, Zambon S, Musacchio E, Sartori L, Perissinotto E, Stubbs B, Crepaldi G, Manzato E, Sergi G. Pain Increases the Risk of Developing Frailty in Older Adults with Osteoarthritis. Pain Med. 2017;18(3):414-427. [2]Salaffi F, Carotti M, Grassi W. Health-related quality of life in patients with hip or knee osteoarthritis: comparison of generic and disease-specific instruments. Clin Rheumatol. 2005 Feb;24(1):29-37. [3]Salaffi F, Leardini G, Canesi B, Mannoni A, Fioravanti A, Caporali R, Lapadula G, Punzi L; GOnorthrosis and Quality Of Life Assessment (GOQOLA). Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. Osteoarthritis Cartilage. 2003;11(8):551-60. Disclosure of Interests: None declared