Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation of the joints, especially of the hands. The evaluation of handgrip strength (HS) and pinch strength can be useful to detect reduction in hand function in RA patients. The aim of the study was to compare HS and pinch strength between RA patients (RA Group-RAG) and a non-RA control group (CG) and to relate HS and pinch strength to functional capacity, duration and disease activity in the RAG. Methods: A cross-sectional case control study. The RAG was assessed for disease activity by the Disease Activity Score (DAS-28); for functional capacity by the Health Assessment Questionnaire (HAQ), the Cochin Hand Functional Scale (CHFS) questionnaire, and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire; and for HS and pinch strength (2-point tip-to-tip, lateral or key, and 3-point) using Jamar® and pinch gauge dynamometers, respectively. Associations were analyzed by Pearson and Spearman tests, and groups were compared by the independent samples t test, with a significance level of P < 0.05. Results: The convenience sample included 121 rheumatoid patients and a control group matched by age, sex, and body mass index. The RAG showed lower strength values compared with the CG in all measurements (P < 0.01, 95% CI) and these values were associated with worse performance in the functional questionnaires and greater disease activity and duration. There was a strong correlation among the functional assessment instruments. Conclusions: The decrease in grip and pinch strength, easily measured by portable dynamometers, is a strong indicator of functional disability in RA patients.
Background: Rheumatoid arthritis patients may have an increased risk of falls due to changes caused by the disease such as muscle weakness, joint impairment, reduced mobility and postural instability. The aim of this study was to prospectively analyze the occurrence of falls in RA patients and its risk factors. Methods: A cohort of 86 RA patients were assessed over 1 year for disease activity using the Disease Activity Score (DAS-28), for functionality using the Health Assessment Questionnaire (HAQ), for the characterization of falls and for the use of medications, and they were subjected to the Berg Balance Scale (Berg), Timed Up and Go (TUG), 6-Minute Walk (6MWT) and Short Physical Performance Battery (SPPB) tests. The Kolmogorov-Smirnov, Spearman's correlation, Student's t, Mann-Whitney and chi-square tests were performed with a significance level of P ≤ 0.05. Results: A total of 86 patients were evaluated, of which 48.8% had at least one fall and 75.6% reported having a fear of falling. No association of falls with age, disease duration, functional capacity, disease activity or physical performance was found. Patients with poorer performance in the physical tests had more functional impairment, higher disease activity and more advanced age. No differences in physical or functional performance, disease activity, gender or fear of falling were found between fallers and non-fallers; only a greater amount of medications used was found in the group of fallers. Conclusions: The occurrence of falls was high and associated with a previous history of falls and polypharmacy, with no association with disease activity or duration, functional capacity, physical performance, age or gender.
It was observed that the occurrence of falls and the fear of falling are quite common in this population. The occurrence of falls in this sample of rheumatoid arthritis patients bears no relation to disease activity, functional capacity, or physical fitness tests.
ResumoA artrite reumatoide (AR) é uma doença autoimune infl amatória sistêmica, crônica e progressiva, que pode causar diminuição da mobilidade, força e atividade física, levando a alterações de propriocepção, equilíbrio postural e marcha, que aumentam o risco de queda nesses pacientes. O presente estudo teve como objetivo verifi car se existe correlação entre testes de funcionalidade e equilíbrio em pacientes com AR. Para isso foi feito um corte transversal com a amostra composta por 99 pacientes com diagnóstico de AR de ambos os sexos. Os instrumentos de avaliação do risco de queda usados foram: Escala de Equilíbrio de Berg (Berg), Teste "Timed Up and Go" (TUG), Teste de Caminhada de 6 Minutos e Short Physical Performance Battery (SPPB) ou Bateria de Testes de Guralnik. Feito teste de Kolmogorov-Smirnov para normalidade de distribuição e correlação de Spearman, com nível de signifi cância de p < 0,05. Os pacientes eram 88,9% do sexo feminino e com idade média de 56,15 anos (± 11,64). A idade apresentou correlação fraca, porém signifi cativa de modo que quanto mais velho, pior o desempenho nos testes. O desempenho médio nos instrumentos não colocou esses pacientes com AR como alto risco de queda, porém não há valores de corte específi cos para essa população. Os instrumentos mostraram correlação de moderada a forte entre si (p < 0,01). Conclui-se, portanto, que os testes físicos realizados são correlacionados e representam bem a capacidade física desses pacientes com AR,principalmente entre pessoas a partir dos 41 anos e homens.PALAVRAS-CHAVE: Artrite reumatoide; Acidentes por quedas; Equilíbrio postural; Testes de aptidão.A artrite reumatoide (AR) é uma doença autoimune inflamatória sistêmica, crônica, progressiva e de etiologia desconhecida, caracterizada principalmente pelo comprometimento articular periférico, podendo levar a deformidades, destruição cartilaginosa e óssea [1][2][3][4][5][6] . Pacientes com AR tem um risco aumentado de cair quando comparados com pessoas saudáveis, o que provavelmente se explica pela alta prevalência de fatores de risco associados a quedas nesses pacientes, que podem gerar alterações de propriocepcão, equilíbrio postural e marcha. Esses fatores de risco incluem dor e edema articular em membros inferiores, fraqueza muscular, instabilidade postural, alterações na marcha e no equilíbrio, diminuição da mobilidade e da capacidade funcional, fadiga, sedentarismo, redução da acuidade visual e depressão [7][8][9][10][11][12][13][14][15][16][17] .Em busca da identifi cação de possíveis alterações que predispõe o sujeito a um maior risco de queda, foram elaborados inúmeros instrumentos para avaliação de equilíbrio e controle postural, bem como capacidade funcional. Esses testes são usados para avaliar intervenções ou mesmo identifi car possíveis caidores com base em alguns pontos de corte já bem estabelecidos na literatura para certas populações.Para o presente estudo foram escolhidos alguns dos testes mais usados na literatura com esse objetivo, embora utilizados na maioria das vezes ...
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