{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:30:56Z","timestamp":1792132256264,"version":"4.4.0"},"reference-count":49,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether rheumatoid arthritis (RA) disease activity is associated with frailty both in cross\u2010section and longitudinally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants within the Veterans Affairs Rheumatoid Arthritis (VARA) registry enrolled from 2003 to 2022 were included. The exposure was RA disease activity measured by the Disease Activity Score in 28 joints (DAS28) with erythrocyte sedimentation rate or C\u2010reactive protein. DAS28 was collected at VARA registry enrollment, and the mean DAS28 score was calculated annually and categorized by level of disease activity. The outcome was frailty measured using the Veterans Affairs Frailty Index (VAFI), which was calculated annually from diagnostic and procedural codes. The relationship of DAS28 with VAFI score was examined at baseline and over five years of follow\u2010up. Multivariable linear regression was used for cross\u2010sectional analysis and generalized estimating equations evaluated the associations longitudinally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 2,800 veterans, 89% were male, 76% were White, the mean age was 64\u2009\u00b1 SD\u200911 years, average RA disease duration was 12\u2009\u00b1\u2009SD 11 years, and 28% were frail. A higher DAS28 score was associated with an increasing VAFI score at enrollment (adjusted \u03b2 0.86, 95% confidence interval [CI] 0.63\u20131.08,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001, N\u00a0=\u00a02,800). RA disease activity scores were independently associated with frailty scores over five years of follow\u2010up (adjusted \u03b2 0.53, 95% CI 0.26\u20130.80,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001, n\u00a0=\u00a02,786).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher RA disease activity was associated with increased frailty burden over time. Future studies should assess whether achieving low disease activity or remission can impact frailty burden over time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.80056","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T10:39:46Z","timestamp":1775471986000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Associations of Rheumatoid Arthritis Disease Activity With Frailty Over Five Years of Follow\u2010up"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2754-5233","authenticated-orcid":false,"given":"Courtney N.","family":"Loecker","sequence":"first","affiliation":[{"name":"College of Nursing, University of Nebraska Medical Center  Lincoln Nebraska"},{"name":"VA Nebraska\u2010Western Iowa Health Care System  Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangyuna","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Rheumatology &amp; Immunology, Department of Internal Medicine University of Nebraska Medical Center  Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punyasha","family":"Roul","sequence":"additional","affiliation":[{"name":"Division of Rheumatology &amp; Immunology, Department of Internal Medicine University of Nebraska Medical Center  Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Baraff","sequence":"additional","affiliation":[{"name":"Arthritis Section, VA Puget Sound Health Care System  Seattle Washington"},{"name":"Department of Statistics University of Washington  Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myra S.","family":"Schmaderer","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Nebraska Medical Center  Lincoln Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lani","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Nebraska Medical Center  Lincoln Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleb","family":"Michaud","sequence":"additional","affiliation":[{"name":"Division of Rheumatology &amp; Immunology, Department of Internal Medicine University of Nebraska Medical Center  Omaha Nebraska"},{"name":"FORWARD, The National Databank for Rheumatic Diseases  Wichita Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namrata","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine University of Washington  Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6640-9173","authenticated-orcid":false,"given":"Grant W.","family":"Cannon","sequence":"additional","affiliation":[{"name":"VA Salt Lake City Health Care System  Salt Lake City Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Kunkel","sequence":"additional","affiliation":[{"name":"VA Salt Lake City Health Care System  Salt Lake City Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0897-2272","authenticated-orcid":false,"given":"Ted R.","family":"Mikuls","sequence":"additional","affiliation":[{"name":"VA Nebraska\u2010Western Iowa Health Care System  Omaha Nebraska"},{"name":"Division of Rheumatology &amp; Immunology, Department of Internal Medicine University of Nebraska Medical Center  Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariela R.","family":"Orkaby","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System &amp; Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts"},{"name":"New England VA Boston Healthcare System Geriatric Research Education and Clinical Center  Jamaica Plain Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0799-7563","authenticated-orcid":false,"given":"Joshua F.","family":"Baker","sequence":"additional","affiliation":[{"name":"University of Pennsylvania &amp; Corporal Michael J. 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