Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, Italy.
Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
Front Immunol. 2020 Oct 29;11:576134. doi: 10.3389/fimmu.2020.576134. eCollection 2020.
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 disease-related 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.
衰弱是一种综合征，其特征是多个系统的生理储备和功能下降，导致易感性增加和健康不良后果。虽然在老年人中很常见，但最近的研究强调了衰弱在慢性疾病中的更高患病率，与年龄无关。导致衰弱的病理生理机制尚未完全理解，尽管最近取得了重大进展。在这种情况下，慢性炎症可能通过直接和间接的方式通过肌肉骨骼、内分泌和神经系统等其他系统发挥关键作用。风湿性疾病的特征是慢性炎症和随着时间的推移累积缺陷。因此，最近的研究开始探索衰弱与风湿性疾病之间的联系，在这篇综述中，我们报告了迄今为止所描述的内容。衰弱是动态的，随着时间的推移，8.3%-17.9%的老年人的衰弱状况会自发改善，具有潜在的可逆转性。肌肉力量可能是最重要的影响因素，可以通过训练来改善，这表明需要保持身体活动。毫不奇怪，无论年龄大小，衰弱在患有风湿性疾病的患者中比在健康对照组中更为普遍，并且与高疾病活动度相关，从而影响临床结局，这主要是由于慢性炎症。更重要的是，治疗潜在疾病可以预防衰弱。已经提出了评估风湿性疾病患者衰弱的量表，但需要更大的病例数来验证特定疾病的指标，这可以比单独的人口统计学和疾病相关变量更准确地预测预后。由于副作用的风险，衰弱患者可能更容易受到伤害，并且更难以治疗，因此在临床决策中应考虑衰弱。针对衰弱的临床试验可以确定哪些患者不太可能耐受潜在的有毒药物，并可能从更保守的治疗方案中受益。总之，在风湿病学中实施衰弱概念将有助于更好地了解患者的整体健康状况，进行更精细的风险分层，并制定更个体化的管理策略。
