SLE Women More Frail Than Much Older Healthy Adults, Study Finds

Women with systemic lupus erythematosus (SLE) may be more frail than people 20 years their senior, according to a new study that also associates frailty with poor physical and cognitive function, functional decline, hospitalization, post-surgery complications and mortality.

The study, “Is Frailty A Relevant Concept In SLE?,” appeared in the journal Lupus Science & Medicine. It classified one in five such women as frail — a rate that’s twice as high as that seen in many studies with much older adults.

Frailty may be defined as “a constellation of low weight or weight loss, weakness, slowness, exhaustion and inactivity,” according to researchers who found elements of frailty in lupus.

“Alterations in body composition have been noted in lupus, including higher body fat percentages and corresponding lower lean mass at given weights,” they wrote. “Persons with lupus have been found to exhibit muscle weakness and high levels of fatigue.”

To investigate the prevalence of frailty among lupus patients, the study — conducted by the University of California-San Francisco’s Clinical and Translational Science Institute — followed 152 SLE women (mean age of 48 years) from 2008 to 2009. Researchers assessed frailty by several criteria, including low weight/unintentional weight loss, slow gait (a 4-meter walking test), weakness (grip strength test), exhaustion, and inactivity (physical activity questionnaire). Patients with three or more of these components were deemed “frail,” with one or two were considered “prefrail,” and with none, “robust.”

Researchers also analyzed physical function, using the 36-item Short Form (SF-36) Physical Functioning subscale and Valued Life Activities disability scale, as well as cognitive function (12-test battery) and mortality (up until December 2015).

“In this cohort of women with lupus, a significant portion, one in five, was classified as frail and another one in two as prefrail,” researchers wrote. “This rate of frailty is twice as high as that seen in many studies of adults more than two decades older.”

Moreover, women in the frail group had significantly worse physical functioning than the other groups, and were more likely to have cognitive anomalies and functional decline. Mortality was also higher among frail women (19.4 percent) than among prefrail (3.9 percent) and robust (2.3 percent) women, regardless of age, disease duration and disease damage.

“[F]railty appears to be a relevant concept in lupus, predicting declines in physical and cognitive functioning and higher risk of mortality,” the team concluded. “The effects noted were not simply due to the disease itself — the effects were seen even after [considering] disease activity and damage. Future research can continue to explore the best means to identify frailty in lupus, and, more importantly, best methods to reduce frailty.”