People with vasculitis frequently suffer from frailty, a process that can affect our ability to recover after an illness or a fall, which in turn is linked to poor health outcomes, according to a new study from researchers at Hospital for Special Surgery (HSS) in New York City and colleagues from the University of Pittsburgh and the University of Pennsylvania. 

“Our study highlights the importance of incorporating frailty in the care of patients with vasculitis, and the potential to develop interventions to ameliorate frailty to minimize adverse outcomes and improve the care of these patients,” said Sebastian E. Sattui MD, MS, an Assistant Professor of Medicine and Director of the UPMC Vasculitis Center at the University of Pittsburgh School of Medicine, and former rheumatology and vasculitis fellow at HSS. Dr. Sattui presented the findings at the ACR Convergence 2023 annual meeting of the American College of Rheumatology. 

Vasculitis is a rare inflammatory condition that affects the blood vessels and can lead to organ damage. The disease can be triggered by infections, medications, and certain cancers, as well as systemic autoimmune disease. 

The latest findings come from the ongoing VascStrong study, a prospective, longitudinal analysis of 272 men and women with vasculitis who agreed to participate in two surveys over a 12-month period. 

At baseline, Dr. Sattui and his colleagues collected information on demographics, the types of medications patients were taking, and the specific nature of their condition. They also looked at various patient-reported outcome measures (PROMs), as well as frailty using the self-reported FRAIL scale, which classifies people as robust, pre-frail, and frail. 

Of the participants, 71% were female and the average age was 62.5 years. The most common forms of vasculitis in the group were granulomatosis with polyangiitis (39%), eosinophilic granulomatosis with polyangiitis (14.3%), and microscopic polyangiitis (12.9%). 

At the start of the study, the prevalence of robustness, pre-frailty, and frailty was 47.1%, 33.8%, and 19.1%, respectively. A year later, most people had stayed in those categories (75%, 50.9%, and 66.1% for robust, pre-frailty, and frailty, respectively). 

However, roughly 21% of people who had been robust at the start of the study reported being pre-frail at the second assessment and 10.2% went from pre-frail to frail. In the other direction, 39% went from pre-frail to robust and 25% from frail to pre-frail. Transitions from frail to non-frail (8.9%) or non-frail to frail (3.7%) were uncommon, the researchers found. 

The pattern was similar for patient-reported outcomes, with pre-frail and frail patients reporting worse pain, fatigue, depression, and physical function a year after the initial survey. Significant health events such as hospitalizations, infections, and vasculitis flares occurred more often in patients who were classified as frail at baseline. 

“We know that frailty is associated with worse health outcomes”, said Robert F. Spiera, MD, Director of the Vasculitis and Scleroderma Program at HSS and the senior author on this study. “These findings demonstrate just how common frailty and pre-frailty are in patients in vasculitis, and that frailty is dynamic. This means that it is potentially modifiable in a subset of patients, and interventions that could ameliorate frailty could in this population could be a meaningful outcome measure in clinical trials in vasculitis that could help identify interventions that would improve the lives of our patients with vasculitis.” 

Sattui, Spiera, et al. The Association of Frailty with Outcomes in Patients with Vasculitis. Abstract 1543. Presented Monday Nov. 13, 2023 at ACR Convergence 2023.