Characterization of falls in adults with established rheumatoid arthritis and associated factors

Abstract

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.

Association between sarcopenia, physical performance and falls in patients with rheumatoid arthritis: a 1-year prospective study

“…Physical performance tests such as SPPB, including gait speed and chair rise test did not reveal significant differences between fallers and non-fallers and were also not significant predictors for falls in the univariate analyses. These results reflect those of Lourenco et al [50], who also found no prospective association of SPPB with falls in patients with RA. Gait speed alone was also a superior predictor to SPPB in the cross-sectional study by Dietzel et al [53].…”

“…Since this was a population with low RA disease activity, it might not be surprising that the association with disease activity was not demonstrated. The RA disease duration has been described by numerous studies as a non-significant factor for falls [6,7,12,50]. This is also supported by the present study results showing no association with falls and duration of disease or disease activity (DAS28 CRP ).…”

“…Nevertheless, age was an independent risk factor for falls in this study. The majority of studies with RA patients have found no association of age and falls [5,13,45,50]. This is surprising, given the fact that cohorts of healthy subjects showed a strong association between the parameters age and falls [51]; thus, is widely accepted as a risk factor for falls from the age of 65 years onwards [52].…”

Prevalence and risk factors for falls in patients with spondyloarthritis: A systematic review

“…Fall prevalence in patients with SpA ranged between 13% 11 to 25.4% 9 across the 3 studies, and appears to be largely similar to patients with rheumatoid arthritis (RA) (range between 10% to 43%). 15,20 Patients with RA often have peripheral joint arthritis, and this can affect their mobility and impose postural instability, 20 which can similarly affect SpA patients with peripheral arthritis, which has been known to affect 30% of patients with SpA. 10 Despite patients with SpA being generally younger, prevalence of falls in patients with SpA was also largely similar to that in the older adult population which ranged from 17.2% in Singapore 21 to 42.4% in the UK.…”

Care complexity individual factors associated with adverse events and in-hospital mortality

“…First, edema is a strong risk factor for hospitalization [50] and skin tear development [51]. Second, immunosuppressed patients have an increased risk of falls due to disease or treatment-related consequences such as muscle weakness, joint impairment, reduced mobility and postural instability [52]. Third, involuntary movements and muscle weakness are common in patients with neurodegenerative diseases, increasing the risk of aspiration due to swallowing dysfunction [53].…”