Is Frailty a Relevant Concept in Systemic Lupus Erythematosus (SLE)?

Patricia P. Katz¹, James Andrews², Edward H. Yelin¹ and Jinoos Yazdany¹, ¹Medicine/Rheumatology, University of California, San Francisco, San Francisco, CA, ²Rheumatology, University of Washington, Seattle, WA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: functional status, Morbidity and mortality and systemic lupus erythematosus (SLE)

Session Information

Date: Tuesday, November 15, 2016

Title: ARHP V: Epidemiology and Public Health

Session Type: ARHP Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Frailty, a syndrome of weight loss, weakness, slowness, exhaustion, and inactivity, has been examined primarily in geriatric cohorts and is associated with poor health outcomes, including mortality. Components of the frailty syndrome are relevant to SLE, but frailty has not been examined in SLE.

Methods: In an in-person research visit (2008-2009), frailty components defined by Fried¹ were assessed: unintentional weight loss, slow gait (based on 4-meter walk using sex and height criteria), weakness (grip strength, gender and BMI criteria), exhaustion (2 specific questions), and inactivity (physical activity questionnaire). Accumulation of 3+ deficits classifies an individual as “frail,” one or two deficits as “pre-frail,” and none as “robust.” Outcomes examined were physical function, cognitive function, and mortality. Physical function was measured with the SF-36 Physical Functioning subscale (score range 0-100) and the Valued Life Activities (VLA) disability scale (range 0-3). Cognitive functioning was measured with a 12-test battery. Scores on each test below -1.0 SD of age-adjusted population norms were considered “impaired.” Subjects were classified as cognitively impaired if they were impaired on ≥1/3 of indices completed. Mortality was determined as of December 2015. Differences in function and two-year changes in function were examined using multiple regression analyses controlling for age, SLE duration, race/ethnicity, glucocorticoid use, obesity, self-reported SLE activity and damage, and, for longitudinal analyses, baseline function. Analyses include women (n=138).

Results: Mean age was 48 (±12) years, mean SLE duration 16 (±9) years. 65% were white, non-Hispanic. 24% of the sample was classified as frail, and 48% as pre-frail (Table 1). Frail women had significantly worse physical function than robust and pre-frail women and were more likely to have cognitive impairment (Table 2). Frail women were also more likely to experience declines in function and onset of cognitive impairment. Mortality rates were significantly higher in the frail group (frail 16.7%; pre-frail 4.1%; robust 2.3%). Odds (95% CI) of death for frail women were elevated, even after adjusting for age, SLE duration, and baseline disease damage (5.1 [0.5, 51.3]).

Conclusion: Prevalence of frailty in this sample of women with lupus was more than double the prevalence in older adults. Frailty was associated with poor physical and cognitive function, functional declines, and mortality. ¹ Fried J et al. Gerontol A Med Sci 2001; 56A:M146-M156

Table 1. Prevalence of frailty components and categorization, compared to other cohorts
		Older community-dwelling adults
	Women with lupus	Fried, 2001¹	Collard, 2012²	Shamliyan, 2013³
Age	48.5 ± 12.6	≥ 65	≥65	≥65
n	138	5317	56,183 (20 studies)	— (24 studies)
Frailty components
Weight loss	22%	6%	—	—
Exhaustion	45%	17%	—	—
Slow gait	9%	20%	—	—
Weakness	38%	20%	—	—
Inactive	29%	22%	—	—

Frailty classification*
Robust (0)	28%	46%	46%	—
Pre-frail (1, 2)	48%	47%	44%	—
Frail (3+)	24%	7%	10%	14%
¹ Fried J et al. Gerontol A Med Sci 2001; 56A:M146-M156 ² Collard R et al. J Am Geriatrics Soc 2012; 60:1487-1492 (systematic review) ³ Shamliyan T et al. Ageing Res Rev 2013; 12:719-736 (systematic review) *Frailty category: Presence of no deficits = Robust; 1 or 2 deficits = Pre-frail; ≥3 deficits = Frail

Table 2. Functioning by frailty classification: Cross-sectional and longitudinal analyses
	Cross-sectional, multivariate			Longitudinal, multivariate
Frailty classification	VLA mean difficulty	SF-36 PF	Cognitive impairment	VLA mean difficulty	SF-36 PF	Cognitive impairment
Robust (n = 42, 28%)	— (reference)	— (reference)	— (reference)	— (reference)	— (reference)	— (reference)
Pre-frail (n = 66, 48%)	0.32 (<.0001)	-5.3 (.0009)	2.0 (0.6, 6.5)	0.09 (.07)	–2.1 (.24)	4.4 (0.4, 50.4)
Frail (n = 30,24%)	0.65 (<.0001)	-11.7 (<.0001)†	4.4 (1.01, 19.6)	0.32 (.001)	-8.0 (.002)	26.2 (1.0, 716.4)
• For VLA and SF-36PF, values are beta (p-value) from multiple linear regression • For cognitive impairment, values are odds ratio (95% confidence interval) from multiple logistic regression
• Cross-sectional multivariate analyses controlled for age, duration, low education, race, oral steroids, obesity, Systemic Lupus Activity Questionnaire (SLAQ), and Brief Index of Lupus Damage (BILD)
• Longitudinal analyses: Baseline frailty component/category predicting change in function 2 years later. Controlled for age, duration, low education, race, oral steroids, obesity, SLAQ, BILD, and baseline value of function

Disclosure: P. P. Katz, None; J. Andrews, None; E. H. Yelin, None; J. Yazdany, None.

To cite this abstract in AMA style:

Katz PP, Andrews J, Yelin EH, Yazdany J. Is Frailty a Relevant Concept in Systemic Lupus Erythematosus (SLE)? [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/is-frailty-a-relevant-concept-in-systemic-lupus-erythematosus-sle/. Accessed .

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