Frailty in systemic lupus erythematosus:A scoping review

Abstract

Objective

This scoping review aimed to explore studies concerning frailty in patients with SLE, focusing on clarifying the prevalence of frailty, the assessment tools used, the influencing factors, and the adverse effects of frailty on the health outcomes of patients with SLE, and to suggest future research directions.

Methods

A systematic search was conducted in PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, WeiPu (VIP), and China Biomedical Literature Service System for studies related to frailty in SLE patients. The search timeframe extended from the inception of the databases to July 26, 2025. Information from the included literature was extracted and summarized.

Results

A total of 22 studies were included. Qualitative age stratification reveals higher frailty prevalence in elderly SLE patients (43.7%-83.5%) versus stable rates in non-elderly adults (16.0%-28.8%); unstratified cohorts show notably wider variation (6.2%-80.9%). Seven evaluation tools were identified, with SLICC-FI and FP being the most frequently used. Influencing factors were categorized as sociodemographic, disease-related, medication-related, and other factors. The adverse effects of frailty on the health outcomes of SLE patients included increased emergency department utilization, hospitalization rate, readmission rate, mortality, and risk of complications. Declines in physical function, activity ability, quality of life, and potential cumulative injuries, pain, fatigue, and disability were also observed.

Conclusion

A difference in frailty prevalence exists between elderly and elderly-excluded adult SLE patients, indicating the need for age-stratified management strategies. The SPPB is currently not advised for frailty assessment in SLE patients. Regarding the remaining six tools, their diverse characteristics necessitate multifactorial considerations in clinical adoption. Current evidence regarding the influencing factors of frailty in SLE remains insufficient, necessitating focused investigations of modifiable factors. While frailty substantially compromises the health status of patients with SLE, no intervention studies have been identified in the extant literature. Prioritizing intervention research is a critical pathway for delaying frailty progression and enhancing the quality of life in this vulnerable cohort.