Association between frailty and oral function in rheumatoid arthritis patients: A multi-center, observational study
Yasumori Sobue1
, Mochihito Suzuki2, Yoshifumi Ohashi3, Ryo Sato2, Yusuke Ohno2, Junya Hasegawa2, Takaya Sugiura2, Kenya Terabe2, Shuji Asai2, Shiro Imagama2
1Department of Orthopedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Achi, Japan
2Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Achi, Japan
3Department of Orthopedic Surgery, Aichi Medical University, Graduate School of Medicine, Nagakute, Aichi, Japan
Keywords: Frailty; laughter; oral function; rheumatoid arthritis, the Kihon checklist.
Abstract
Objectives: This study aims to investigate the association between frailty and oral function in rheumatoid arthritis (RA) patients and to identify practical markers for early frailty detection and potential intervention strategies.
Patients and methods: A multi-center observational cohort study (T-FLAG) included a total of 661 RA patients (186 males, 475 females; mean age: 68.5±13.5 years; range, 18 to 100 years) between June 2023 and August 2023. Frailty was assessed using the Kihon Checklist (KCL) (frailty: score ≥8). Oral function scores were based on Question 13 (“difficulty eating hard foods”), Question 14 (“choking”), and Question 15 (“dry mouth”) of the KCL. Receiver operating characteristic (ROC) curves were generated to assess the association between frailty and oral function scores. Multivariate logistic regression was used to analyze factors associated with oral function.
Results: Among the 661 participants, 39.5% were frail. Frailty rates tended to increase with increasing oral function scores. The optimal cut-off score for oral function corresponding to frailty was 2 points, with a specificity of 89.2% and a sensitivity of 54.8%. Multivariate analysis identified age and Health Assessment Questionnaire-Disability Index (HAQ-DI) as significant factors associated with oral function decline (i.e., a total score of ≥2 for Questions 13-15 of the KCL).
Conclusion: Frailty is strongly associated with oral function decline in RA patients. This finding highlights the importance of monitoring the oral function of RA patients, since it not only reflects physical function, but also serves as a potential marker of frailty. Targeted interventions to improve oral function may play a vital role in reducing frailty risk and enhancing the overall well-being of RA patients.
Citation: Sobue Y, Suzuki M, Ohashi Y, Sato R, Ohno Y, Hasegawa J, et al. Association between frailty and oral function in rheumatoid arthritis patients: A multi-center, observational study. Arch Rheumatol 2025;40(1):15-27. doi: 10.46497/ ArchRheumatol.2025.11039.
Idea/concept, design, control/supervision, data collection and/or processing, analysis and/or interpretation, literature review, writing the article, and critical review: Y.S., M.S., Y.O.; Contributed to data collection and/or processing and critical review: R.S., Y.O., J.H., T.S., K.T., S.A.; Control/supervision, idea/concept, design, and critical review: S.I. All authors read and approved the final manuscript.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
We thank Dr. Koji Funahashi, Dr. Hiroshi Koshima, Dr. Nobuyuki Okui, Dr. Hisato Ishikawa, Ms. Sachiko Kato, Ms. Emi Yokota, Ms. Ritsuko Otake, and Ms. Takako Sashikata for their assistance in information collection.
The authors also thank ChatGPT for assistance with writing and spelling corrections. The responsibility for the content accuracy, data interpretation, and final approval of the manuscript rests solely with the authors.Additionally, the authors received English language editing services from ProEdit Japan, Inc.
The data that support the findings of this study are available from the corresponding author upon reasonable request.