Reversibility of social frailty in patients with rheumatoid arthritis: A longitudinal analysis of the multicenter observational (T-FLAG) study data

BACKGROUND: Social frailty, characterized by reduced social participation and support, is associated with adverse outcomes. Although patients with rheumatoid arthritis (RA) are at increased risk of social frailty, longitudinal changes remain unclear. This study investigated the reversibility of social frailty and associated factors in RA. METHODS: This longitudinal analysis was based on a multicenter observational cohort. Social frailty was assessed using the Social Frailty Index. Among the 605 patients with RA, 216 who were socially frail at baseline were enrolled. Improvement was defined as a reduction in score from ≥2 to ≤1 at 1-year follow-up. Multivariate logistic regression adjusted for age, sex, disease duration, disease activity, educational level, marital status, and Health Assessment Questionnaire Disability Index (HAQ-DI) was performed, and frequency of laughter was additionally included. RESULTS: Of the 216 patients, 87 (40.2%) improved after 1 year. Age and marital status were independently associated with improvement (OR [95% CI]: 0.99 [0.98-0.99] and 3.73 [1.97-7.05], respectively), whereas disease activity and educational level were not associated with improvement. Although frequency of laughter was significant in one model, this effect was not consistently demonstrated. HAQ-DI showed a trend but was not an independent factor. Component analysis showed higher improvement in social roles, daily conversation, and going out, whereas living alone showed minimal change. CONCLUSIONS: Among patients with baseline social frailty, social frailty in RA appears to be partially reversible. Marital status was independently associated with improvement, whereas disease activity was not.