Malnutrition Complicates Quality of Life in Elderly Patients With RA

Patients with rheumatoid arthritis (RA) who are also malnourished are more limited in their daily activity, have lower cognitive function, and are more frail than peers with RA who are not malnourished, according to a new study.

Writing in the journal Nutrients, corresponding author Beata Jankowska-Polańska, PhD, of Poland’s Wroclaw Medical University, and colleagues explained that RA can have a significant effect on all aspects of patients’ lives, adding that patients with RA who are elderly often are treated less aggressively than their younger peers.

In addition, patients with RA often suffer from a lack of nutrition, the investigators wrote. The characteristic pattern of weight in patients with RA begins with mild obesity early in the disease, but then changes, the authors said.

“As the condition progresses, skeletal muscle protein levels drop and BMI [body mass index] continually decreases, mainly due to rheumatoid cachexia, loss of lean body mass, and metabolic disturbances caused by increased proinflammatory cytokine levels,” they wrote.

Patients with major BMI shifts and malnutrition tend to have poorer long-term outcomes, including lower life expectancy and mental health problems, Jankowska-Polańska and colleagues said. However, malnutrition’s effect on quality of life (QOL) had yet to be studied specifically in patients with RA.

The investigators recruited 98 patients, all over the age of 60, and assessed them for quality of life, frailty, nutritional status, and cognitive impairment, using a variety of scoring systems. They also pulled medical data from patient hospital records. They wanted to see whether malnutrition was associated with factors associated with quality of life. Their hypothesis proved correct.

Patients with lower body weight had significantly higher rates of dementia (33.33% among malnourished patients, versus 1.79% among patients with normal body weight). One-third of malnourished patients had mild frailty syndrome, and another third had either moderate (16.67%) or severe (16.67%) frailty syndrome.

“In our study, frailty was the strongest negative independent determinant of QoL in all the QoL domains studied,” the authors reported.

Yet, while more malnutrition was linked with lower quality of life, malnutrition itself was not an independent determinant of lower quality of life.

Jankowska-Polańska said the particular impact of RA on a patient’s life will vary from patient to patient.

“The quality of life of the sick is the result of a single and unique interaction of the influence of the disease, the patient’s individual abilities, adaptation forces and coping processes of dealing with the disease,” the authors wrote.

Jankowska-Polańska and colleagues said their findings represent an under-researched issue in rheumatology, and one that warrants further study in order to better understand how nutritional status impacts patients with RA.

In the meantime, they said, “RA patients should be routinely screened for malnutrition and frailty, so that preventive measures can be implemented to reduce the risk of these conditions and minimize their QoL impact.”

They noted that some evidence suggests nutritional programs and rehabilitation, including protein supplementation can help improve quality of life and address frailty.

The authors said their study was limited by its relatively small sample size and by the fact that it only used a single self-reported instrument to evaluate frailty, a topic that lacks a universally accepted assessment tool.

Reference

Tański W, Wójciga J, Jankowska-Polańska B. Association between malnutrition and quality of life in elderly patients with rheumatoid arthritis. Nutrients. 2021;13(4):1259. Published online April 12, 2021. doi:10.3390/nu13041259