A consecutive 2-year increase in the modified health assessment questionnaire score is associated with subsequent fractures in patients with rheumatoid arthritis

OBJECTIVES: Rheumatoid arthritis (RA) is a well-recognised risk factor for fractures. However, short-term fracture risk factors remain unclear. This study aimed to elucidate factors useful for short-term fracture prevention. METHODS: Patients were enrolled in the National Database of Rheumatic Diseases in Japan (2002-2020) were analysed. Modifiable risk factors included changes in disease activity, modified health assessment questionnaire (mHAQ) scores and oral glucocorticoid usage. RESULTS: Of the 37,466 patients with RA enrolled, 1655 experienced a first fracture. Sex, age, disease duration, disease activity, mHAQ score and glucocorticoid usage significantly differed between patients with and without fractures. Among 734 with 4-year pre-fracture data, mHAQ scores gradually increased over consecutive years before the fracture. When classified into four groups according to mHAQ changes over 2 consecutive years, patients with continuous increases had significantly higher fracture incidence (2.13%) than those with increases only in years 1-2 (1.43%), only in years 2-3 (1.59%) or with no increase across 2 consecutive years). CONCLUSIONS: A consecutive 2-year increase in mHAQ score is associated with an increased risk of subsequent fracture in patients with RA, offering valuable insight for targeted fracture prevention strategies.