Frailty in Rheumatic Diseases.
Frailty in Rheumatic Diseases.
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DOI：
10.3389/fimmu.2020.576134
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发表时间：
2020
影响因子：
7.3
通讯作者：
Selmi C
中科院分区：
文献类型：
--
作者：
Motta F;Sica A;Selmi C
虚弱是一种综合征，其特征是几个系统的生理储备和功能下降，导致脆弱性增加和不良健康结果。虽然在老年人中很常见，但最近的研究强调，与年龄无关的慢性疾病中虚弱的患病率更高。虽然最近取得了重大进展，但导致脆弱的病理生理机制尚未完全了解。在这种情况下，慢性炎症可能直接或间接地通过其他系统（如肌肉骨骼、内分泌和神经系统）发挥关键作用。风湿病的特点是慢性炎症和长期积累的缺陷。因此，研究最近开始探索虚弱和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。虚弱是动态的，可能是可逆的，8.3%-17.9%的老年人随着时间的推移会自发地改善他们的虚弱状态。肌肉力量可能是最重要的影响因素，可以通过训练来改善，因此指出需要保持体力活动。毫不奇怪，与健康对照者相比，受风湿病影响的患者，无论年龄大小，虚弱都更为普遍，并且与高疾病活动性相关，从而影响临床结果，主要是由于慢性炎症。更重要的是，对潜在疾病的治疗可以预防虚弱。已经提出了评估风湿病患者虚弱程度的量表，但需要更大的随机试验来验证疾病特异性指标，这可能比单独的人口统计学和疾病相关变量更准确地估计预后。由于存在副作用的风险，体弱多病的患者可能更容易受到伤害，也更难以治疗，因此在临床决策时应考虑到体弱多病。针对虚弱的临床试验可以确定那些不太可能耐受潜在毒性药物的患者，并可能从更保守的治疗方案中受益。总之，在风湿病学中实施虚弱概念将有助于更好地了解患者的整体健康状况，提供最精细的风险分层和更个性化的管理策略。
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.