FRAILTY, a dynamic and clinically significant condition, is prevalent among patients with systemic sclerosis (SSc), according to a recently published study. The findings, derived from the Australian Scleroderma Cohort Study, underscore the importance of identifying and managing frailty to improve patient outcomes.
Researchers evaluated 1,703 patients meeting ACR/EULAR criteria for SSc using the FRAIL Scale, categorizing participants as robust, pre-frail, or frail. The study revealed that frailty and pre-frailty are common in this population, affecting 14% and 53% of patients, respectively. Notably, only 33% of participants consistently maintained a robust status.
Frailty was shown to be a dynamic state, with potential for improvement or progression over time. Among those initially categorized as frail, 60% improved to pre-frail or robust status, while 40% remained frail. Conversely, 15% of pre-frail participants transitioned to frailty, and one-third of robust individuals progressed to a frail or pre-frail state.
The study highlighted several determinants of frailty in SSc patients. Disease-specific factors such as diffuse SSc (OR 1.4), pulmonary arterial hypertension (OR 7.1), interstitial lung disease (OR 1.6), proximal weakness (OR 1.5), and gastrointestinal symptoms (OR 1.5) significantly increased frailty risk. Non-SSc factors, including older age (OR 1.1), elevated CRP (OR 1.7), and anemia (OR 1.4), were also associated with frailty.
The implications of frailty in SSc extend to health outcomes. Both frailty and pre-frailty states were linked to a reduced quality of life, diminished physical function, and increased mortality. Specifically, the hazard ratios for death were 3.5 for pre-frail patients and 9.8 for frail patients, emphasizing the critical need for early intervention.
These findings underscore the necessity of incorporating frailty assessments into routine care for SSc patients. Proactive management and targeted interventions could mitigate progression and enhance patient outcomes.
By shedding light on the interplay between frailty and systemic sclerosis, this study provides a foundation for improved clinical strategies to address the complex needs of this vulnerable patient population.
Reference: Fairley JL et al. Progression and clinical implications of frailty in patients with systemic sclerosis. Clin Rheumatol. 2025;44:305-317.
Anaya Malik | AMJ
