Among women with systemic lupus erythematosus (SLE), higher baseline scores on the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) are associated with higher risk for damage accrual during follow-up, according to study results published in Arthritis Care & Research.

In a secondary analysis of data from the Study of Lupus Vascular and Bone Long-Term Endpoints cohort, researchers enrolled 185 adult women diagnosed with SLE. Of these patients, 149 were included in a 5-year follow-up. At baseline and follow-up, both the SLICC-FI and SLICC/American College of Rheumatology (ACR)-Damage Index (SDI) scores were calculated.

At baseline, patients had a mean age of 43.30±10.15 years and a mean disease duration of 11.93±8.46 years. The mean baseline SDI score was 1.64±1.83; the mean baseline SLICC-FI score was 0.18±0.08; and 36% of participants were categorized as “frail,” based on SLICC-FI scores greater than 0.21. At the 5-year follow-up, increases in SDI of at least 1 occurred in 58 (38.9%) of patients, whereas 91 (61.1%) patients had no change in SDI.

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Univariable analysis showed that no potential confounders were associated with risk for damage accrual at 5 years. The unadjusted analysis revealed a 28% higher odds of subsequent damage accrual (odds ratio [OR], 1.28; 95% CI, 1.03-1.60) with every 0.05-unit increase of baseline SLICC-FI score. This association remained significant after a multivariable analysis controlling for age, race, and disease duration (adjusted OR, 1.28; 95% CI, 1.01-1.63). There was no significant association between damage accrual at 5 years and baseline SDI score.

The statistical power of the study was limited by the sample size. Other study limitations included the enrollment of primarily well-educated women that limited generalizability; some patients (n=36) not completing the 5-year follow-up visits may have introduced selection bias; and the predictive validity of SLICC-FI scores for mortality risk could not be evaluated.

According to the researchers, “…this is the first study to externally validate the SLICC-FI in a prevalent cohort of women with more longstanding SLE.” They added, “Unlike damage, frailty is reversible and future work should investigate how an individual’s SLICC-FI trajectory impacts health outcomes, as well as the potential usefulness of the SLICC-FI as an outcome measure in future SLE intervention studies.”


Lima K, Legge A, Hanly JG, et al. Association of the Systemic Lupus International Collaborating Clinics Frailty Index and damage accrual in long standing systemic lupus erythematosus. Arthritis Care Res. Published online September 30, 2021. doi:10.1002/acr.24798