Frailty in Women with Lupus Is Associated with Poorer Outcomes

Frailty, a syndrome of weight loss, weakness, slowness, exhaustion and inactivity, may predict reduced physical and cognitive function and a high risk of mortality in women with systemic lupus erythematosus.

Patricia P. Katz, PhD, of the University of California, San Francisco School of Medicine, reported these findings at the 2016 American College of Rheumatology (ACR) Annual Meeting. Her presentation was titled “Is Frailty a Relevant Concept in Systemic Lupus Erythematosus (SLE)?”

The team studied 138 women with lupus between 2008 and 2009. The participants, whose mean age was 48, were evaluated for frailty components of weight loss, weakness, slowness, exhaustion and inactivity.

Patients with deficits in three or more of the five categories were deemed frail and patients with deficits in one or two categories were considered pre-frail. “Robust” patients showed no deficits.

Researchers classified 24 percent of the women as frail and 48% as pre-frail.

Weakness was determined by a grip strength test and slowness by a four-meter walk. Exhaustion and inactivity were determined with a questionnaire.

Physical function was assessed with the SF-36 Physical Functioning subscale, a patient-reported survey about their health, and the Valued Life Activities disability scale, which assesses difficulty in a broad array of activities.

Cognitive function was assessed with a battery of 12 tests. Mortality was determined as of December 15, 2015.

“Frail women had significantly worse physical function than robust and pre-frail women and were more likely to have cognitive impairment,” the team wrote in an abstract. “Frail women were also more likely to experience declines in function and onset of cognitive impairment.”

The rate of mortality was 16.7% in the frail group, 4.1% in the pre-frail group, and 2.3% in the robust group.

“Prevalence of frailty in this sample of women with lupus was more than double the prevalence in older adults,” the team wrote. “Frailty was associated with poor physical and cognitive function, functional declines, and mortality.”

“It does appear that frailty is something that might be a relevant concept in lupus, and it does predict declines in physical and cognitive functioning and a high risk of mortality,” Katz said during her presentation, according to a news release. “The effects were not simply due to disease itself, because we saw these effects even after adjusting for disease activity and damage. The combination of frailty components appeared to create a combined risk for poor outcomes that was greater than any of the elements alone.”

“In terms of future directions, it may be important to try and develop a lupus-specific measure,” Katz added. “It may need to include different measures or additional factors.”