Study Compares Frailty Measures in SLE, Identifies SLICC-FI as Most Predictive of Outcomes
A comparative analysis of frailty assessments in systemic lupus erythematosus (SLE) has found that while multiple frailty measures identify patients at risk for poor health outcomes, the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) demonstrated the most consistent associations with both cross-sectional and longitudinal clinical indicators. The findings provide evidence to guide frailty assessment selection in rheumatologic practice.
Using data from the California Lupus Epidemiology Study, researchers evaluated four measures: the SLICC-FI, Short Physical Performance Battery (SPPB), the FRAIL scale questionnaire, and the Patient-Reported Outcomes Measurement Information System Physical Function 10a (PF) as a proxy. Frailty classification varied widely depending on the instrument used, ranging from 10.8% (SPPB) to 45.9% (FRAIL).
Agreement between measures was inconsistent. Kappa statistics (k) ranged from 0.17 to 0.63, reflecting only slight to substantial concordance. This variability highlights the challenge in standardizing frailty assessment in SLE populations. However, most measures—excluding SPPB—were significantly associated with poor outcomes, including hospitalization, disability in valued life activities, cognitive impairment, self-reported disease damage, fatigue, and depressive symptoms.
“SLICC-FI had the most consistent association with outcomes, followed by FRAIL and PF,” the authors reported. SLICC-FI was the only measure consistently linked to both immediate and future adverse outcomes, including disease damage increase and hospitalization over a three-year follow-up.
Importantly, the SPPB—a performance-based test of lower extremity function—was the only measure not associated with the majority of outcomes. This raises concerns about its sensitivity in SLE populations, where fatigue and systemic manifestations may influence frailty more than physical performance alone.
In choosing a frailty measure for clinical or research use, the study emphasizes practicality and purpose. “The intended use, as well as the simplicity and practicality of implementing the measure, may be the most important considerations in choosing a frailty measure,” the authors concluded.
For practicing rheumatologists, this study reinforces the relevance of frailty as a clinical construct in SLE and supports the use of SLICC-FI or FRAIL as accessible, predictive tools for identifying patients at heightened risk for adverse health outcomes. Integrating frailty screening into routine assessments may improve risk stratification and inform management strategies in SLE care.
Reference
Katz P, Dall'Era M, Plantinga L, Barbour KE, Greenlund KJ, Yazdany J. Measuring frailty in systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2025;77(6):700-709. doi:10.1002/acr.25479
