Document resource
Introduction Frailty is a state of increased vulnerability due to functional decline and reduced reserve capacity and observed in connective tissue diseases. Systemic sclerosis (SSc) itself has a high mortality rate and frailty is considered as a predictor of morbidity and mortality. However, the relationship between frailty and the disease status of SSc were still unclear. Also, we experienced frailed patients even without severe organ involvements. This study aimed to clarify the association between physical frailty and baseline characteristics in non-severe SSc patients.Material and Methods SSc patients who visited an outpatient clinic in Fujita Health University Hospital between 2021 and 2024 were included. Patients with SSc were fulfilled the 2013 ACR/EULAR classification criteria and did not met step 1 criteria of the revised American College of Rheumatology Composite Response Index in Systemic Sclerosis (ACR-CRISS). Physical frailty was assessed using the Japanese Criteria for the Diagnosis of Frailty (J-CHS). Body composition was evaluated by Body mass Index (BMI), fat mass index (FMI), and skeletal muscle mass index (SMI). Organ involvement was collected retrospectively, with gastrointestinal (GI) symptoms assessed using Eating Assessment Tool (EAT)-10, Frequency Scale for the Symptoms of GERD (FSSG), and The University of California Los Angels Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument (UCLA GIT)-2.0. Functional disability was evaluated by health assessment questionnaire disability index (HAQ-DI). Associations between frailty and clinical parameters were analyzed using the Jonckheere-Terpstra test.Results Fifty patients were enrolled (mean age at onset 64 ± 13 years, 78% female, 39% dcSSc). As for the Frailty status, 9 (18%) non-frail, 35 (70%) pre-frail, and 6 (12%) frail. Physical frailty was associated with HAQ-DI (p < 0.001), age at onset (p < 0.05), disease duration (p < 0.01), dysphagia, and abdominal distension (both p < 0.03). The patient-reported GI scores were also related: total EAT-10 (p < 0.01), FSSG (p < 0.05), and total UCLA GIT-2.0 (p < 0.05). Of 7 scales in UCLA GIT-2.0, fecal incontinence, social functioning, psychological health, and constipation were associated with frailty (p < 0.05, p < 0.05, p < 0.02, p < 0.02). No associations were found with skin subtype, mRSS, SSc-specific autoantibodies, body composition, pulmonary or cardiac findings, digital ulcers, capillaroscopy, or ILD extent.Conclusions Physical frailty was identified in over 80% of patients with SSc, even without severe organ involvement. Age at onset, disease duration, functional disability, and particularly GI involvement may contribute to frailty in SSc.