Using the Concept of Frailty to Understand Variability in Health Outcomes Among Individuals with Systemic Lupus Erythema
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Other CTD: Inflammatory Myopathies and Sjogren’s (P Basharat and JFL Albayda, Section Editors)
Using the Concept of Frailty to Understand Variability in Health Outcomes Among Individuals with Systemic Lupus Erythematosus Alexandra Legge, MD MSc1 John G. Hanly, MD FRCPC2,* Address 1 Division of Rheumatology, Department of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada *,2 Division of Rheumatology, Department of Medicine, and Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Center, 1341 Summer Street – Suite 245, Halifax, Nova Scotia, Canada B3H 4K4 Email: [email protected]
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Other CTD: Inflammatory Myopathies and Sjogren’s Keywords Frailty I Sarcopenia I Deficit accumulation I Frailty index I Systemic lupus erythematosus
Abstract Purpose of the review Some individuals experience greater susceptibility to adverse health outcomes than others, which is known as frailty. There are two main approaches to operationalizing frailty—the phenotypic approach and the deficit accumulation approach. We review these approaches and discuss their respective strengths and limitations. Both approaches can advance our understanding of the unexplained heterogeneity in health outcomes observed among individuals with systemic lupus erythematosus (SLE). Recent findings A recent study using the frailty phenotype identified a higher than expected prevalence of frailty among women with SLE. Phenotypic frailty was associated with increased risk of subsequent functional decline and mortality. In a separate initiative, data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort was used to construct a frailty index (FI) to measure deficit accumulation in SLE. FI scores in the SLICC inception cohort were higher than expected for similarly aged healthy individuals. Higher SLICC-FI values predicted increased risk of future organ damage accrual and mortality.
Other CTD: Inflammatory Myopathies and Sjogren’s (P Basharat and JFL Albayda, Section Editors) Summary Emerging evidence demonstrates that frailty is a useful concept for improving our understanding of the variability in health outcomes observed among individuals with SLE. Preventing and treating frailty in SLE may lead to reduced morbidity and mortality in this population.
Introduction Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with the potential to involve any organ system [1]. The clinical manifestations of SLE are diverse and highly variable between individuals [1]. Similarly, health outcomes in SLE are heterogeneous and challenging to predict. The clinical course of SLE can range from a relatively benign chronic illness to progressive organ damage and fulminant organ failure. Given this variability in health trajectories, there is an unmet need to identify SLE patients, ideally early in their disease, who are at greatest risk for adv
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