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Frailty a Likely Factor in Lupus Mortality

RM Lupus

Frailty is a condition that can affect anyone, although we mostly associate it with the sick and the aging. It is characterized by weight loss, weakness, slowness, exhaustion, and inactivity. However, findings presented at the American College of Rheumatology Annual Meeting found that it was also associated with mortality, poor physical and cognitive function and overall functional decline in patients with systemic lupus erythematosus.

“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,” Patricia P. Katz, PhD, professor of medicine at the University of California, San Francisco School of Medicine, said during her presentation. “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.”

Katz and his colleagues performed an in-person research visit to 138 women with lupus in a one year span. It was on these visits that they assessed the frailty components of weight loss, weakness, slowness, exhaustion, and inactivity. The researchers determined slowness by a 4-meter walk using sex and height criteria. Weakness was determined by grip strength using sex and BMI criteria, and investigators determined both exhaustion and inactivity with a questionnaire. If the patient had a deficit in at least three of the five categories, researchers deemed the patient to be “frail.” Researchers considered a deficit in one or two categories to be “pre-frail” and a deficit in none of the categorized to be a “robust” patient. Of the patients, the mean age was 48 years; the mean lupus duration was 16 years; and 65% were white, non-Hispanic. Overall, 24% of patients were classified as frail and 48% were classified as pre-frail.

At the end of the study, researchers concluded that frail women had a significantly worse physical function as compared to robust and pre-frail women. Atop of that, frail women were more likely to be found with a cognitive impairment. The mortality rate was 16.7% in the frail group, 4.1% in the pre-frail group and 2.3% in the robust group. In the regression analysis, the frail group had an increased risk for death.

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