Frailty during polymyalgia rheumatica, giant cell arteritis and other inflammatory rheumatic diseases

Recent data suggest a pathophysiological role of aging and immunosenescence during polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), by definition rheumatic disease of the elderly. During aging, there is a decline in major physiological functions (immune system, muscle, cognitive, endocrine, cardiovascular, respiratory and renal functions), which combined with multimorbidity, environmental factors and polypharmacy can lead to frailty. Frailty is a clinical syndrome and dynamic concept including a pre-frailty stage; it reflects a reduction in physiological reserve capacities which alters the mechanisms of adaptation to stress. It results in the inability of a vulnerable subject to return to baseline homoeostasis after minor stress, increasing the risk of hospitalization, loss of autonomy and death. To date, there are no consensual criteria for frailty and its assessment in clinical practice remains difficult, based either on physical criteria including weight loss, fatigue, reduction in muscular strength and walking, inactivity or on a multidimensional geriatric assessment. The impact on morbidity and mortality and quality of life, the possibility of detecting reversible stages of pre-frailty and of implementing preventive measures justify interest in rheumatology as the number of patients aged 65 years and older with inflammatory rheumatic diseases is increasing. If there are no specific recommendations for the management of frailty or pre-frailty, recommendations for exercises, physical activity and nutrition to limit sarcopenia and comorbidities can be applied. The association with multimorbidity and its additive effect reinforces the need for screening, prevention and specific management of comorbidities, particularly infections, osteoporosis, cardiovascular diseases, during chronic inflammatory rheumatic diseases, PMR and GCA.