Frailty in Rheumatic Diseases

Abstract

Frailty is a syndrome characterized by the decline in the physiologic reserve and function of several systems, leading to increased vulnerability and adverse health outcomes. While common in the elderly, recent studies have underlined the higher prevalence of frailty in chronic diseases, independent of age. The pathophysiological mechanisms that contribute to frailty have not been completely understood, although significant progresses have recently been made. In this context, chronic inflammation is likely to play a pivotal role, both directly and indirectly through other systems, such as the musculoskeletal, endocrine, and neurological systems. Rheumatic diseases are characterized by chronic inflammation and accumulation of deficits during time. Therefore, studies have recently started to explore the link between frailty and rheumatic diseases, and in this review, we report what has been described so far. Frailty is dynamic and potentially reversible with 8.3%-17.9% of older adults spontaneously improving their frailty status over time. Muscle strength is likely the most significant influencing factor which could be improved with training thus pointing at the need to maintain physical activity. Not surprisingly, frailty is more prevalent in patients affected by rheumatic diseases than in healthy controls, regardless of age and is associated with high disease activity to affect the clinical outcomes, largely due to chronic inflammation. More importantly, the treatment of the underlying condition may prevent frailty. Scales to assess frailty in patients affected by rheumatic diseases have been proposed, but larger casuistries are needed to validate disease-specific indexes, which could allow more accurate prognostic estimates than demographic and diseaserelated variables alone. Frail patients can be more vulnerable and more difficult to treat, due to the risk of side effects, therefore frailty should be taken into account in clinical decisions. Clinical trials addressing frailty could identify patients who are less likely to tolerate potentially toxic medications and might benefit from more conservative regimens. In conclusion, the implementation of the concept of frailty in rheumatology will allow a better understanding of the patient global health, a finest risk stratification and a more individualized management strategy.

The degree of frailty as a translational measure of health in aging

“…Nevertheless, people living with mild to moderate frailty find their way into trials and bring with them a higher risk of adverse outcomes 135 . In consequence, it has been recommended that people who live with frailty merit closer monitoring 135 , and that trials in chronic diseases in which frailty is common should determine which treatments frailer patients might tolerate best 136 . Indeed, in many subgroups, including younger people, patients with higher degrees of frailty appear to be more likely to benefit from treatment.…”

Pathogenic implications, incidence, and outcomes of COVID-19 in autoimmune inflammatory joint diseases and autoinflammatory disorders

“…Furthermore, patients with RMDs may be associated with an increase frailty, which is defined as a syndrome characterized by a decrease of strength, endurance, reduced physiological function, and increased the individual's vulnerability [77]. The chronic RMD inflammation may possibly contribute to the development of frailty associated with a characteristic pro-inflammatory Tlymphocyte phenotype as well as with an elevated concentration of IL-6 [78].…”

Frailty in inflammatory bowel diseases: an emerging concept

“…Therefore, frailty may be a more accurate construct to prognosticate outcomes in patients with chronic immune-mediated conditions rather than age, demographic, and disease-specific parameters alone. 63 …”