Evaluating Frailty in Systemic Lupus Erythematosus: A Scoping Review

Objectives There is growing interest in using frailty to better understand the heterogeneous health outcomes observed among people living with systemic lupus erythematosus (SLE). This scoping review aimed to 1) Identify and describe the tools and measures used to characterize frailty in SLE; 2) Describe the associations of frailty with cross-sectional and longitudinal outcomes in SLE; and 3) Compare the estimated prevalence of frailty in SLE across studies.

Methods This study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A comprehensive search was conducted in Ovid MEDLINE, Embase, Cochrane Library and Scopus from inception to July 14th, 2025. The search strategy used keywords and Medical Subject Headings for “systemic lupus erythematosus” and “frailty.” Included articles were English language full-length original research articles of any study design that described the use of a frailty measure/tool in patients with SLE. Data were extracted using a standardized form by 2 independent reviewers. Risk of bias assessment was done using the NHLBI Quality Assessment Tool for Observational Cohorts and Cross-Sectional Studies.

Results The search yielded 797 articles for title/abstract screening, of which 83 underwent full text review. Twenty-four articles were included (14 cohort studies, 10 cross-sectional studies). All included studies received an overall rating of “fair” or “good” in the risk of bias assessment. Frailty was assessed using 6 different measures. One specifically constructed for use in SLE, the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI), was the most frequently used (15 studies), followed by the Fried phenotype (5 studies) and FRAIL scale (5 studies) (Table 1). The prevalence of frailty was reported by all 24 studies, ranging from 6.2% to 80.9%. Older age was positively associated with frailty in 8 of 13 studies. In univariable analyses, regardless of the measure used, frailty was associated with an increased risk of adverse outcomes during follow-up, including damage accrual, hospitalizations, and mortality, as well as worsening disability, quality of life and cognitive impairment.

Conclusion Several different tools are used to measure frailty among people living with SLE. Regardless of whether it is measured using the phenotypic approach or the deficit accumulation approach, frailty is consistently associated with an increased risk of adverse health outcomes in SLE. The optimal approach for measuring frailty in this population may vary across different clinical and research contexts.