Balance and Falls in Axial Spondyloarthritis: A Cross Sectional Study.

Abstract

BACKGROUND Background: Spondyloarthritis (SpA) patients, mainly those with advanced disease, may have postural difficulties. In these patients the spine may became stiff due to the chronic inflammatory process of fibroconnective tissues and bones, leading to hip flexion, increase in dorsal kyphosis and loss of lumbar and cervical lordosis. Knee flexion occurs as a compensatory mechanism promoting the appearance of the classic skier posture. Such malalignment causes dislocation of the center of mass of the trunk, disturbing static and dynamic balance. It also causes difficulties in looking up and creating visual inputs that are important to compensate the negative effects of postural instability. Aim: To study balance impairment and falls in SpA patients and its association with clinical and epidemiological variables, disease activity, functional and metrology indexes. MATERIALS AND METHODS Materials and methods: Cross sectional study of 55 SpA patients with axial disease. Clinical and epidemiological were collected from the charts. Balance was accessed by Berg Balance Scale (BBS). The following instruments were applied: ASDAS (Ankylosing Spondylitis Disease Activity Score)-ESR, ASDAS-CRP, BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), BASMI (Bath Ankylosing Spondylitis Metrology Index) and ASQoL (Ankylosing spondylitis quality of life questionnaire). The number of falls in the last year was collected. RESULTS Results: In this sample, 30.9% had high risk of falls by the BBS and 25.4% recalled having at least one fall in the last years. The BBS values were lower in those with white ethnic background (p=0.01); smokers (p=0.03) and with HLA-B27 (p=0.03) and correlated inversely with BASDAI (rho=-0.28), ASDAS-ESR (rho=-0.32) and ASDAS-CRP (rho=-0.33), BASFI (rho=-0.71,p<0.0001), BASMI (rho=-0.80; p<0.0001), and age (rho=-0.50;p<0.001). Multivariated analysis showed that BASFI and BASMI were independently associated with BBS (p=0.02 and 0.0001 respectively). Patients with falls had lower BBS (p=0.03) and loss of balance correlated with impairment of the quality of life (rho=-0.56;p<0.001). CONCLUSION Conclusions: Conclusions: Balance is impaired in almost 1/3 of SpA patients and the BBS is associated mainly with functional and metrology indexes, showing that patients with severe cumulative damage are more affected.

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

“…Studies were conducted in 2 countries -Turkey (n = 2) 10,11 and Brazil (n = 1). 9 The number of patients across the 3 studies was 441 and ranged from 55 9 to 306. 11 The mean age of patients ranged from 37.2 10 to 47.8 years.…”

“…11 The mean age of patients ranged from 37.2 10 to 47.8 years. 9 All 3 studies included patients with a diagnosis of ankylosing spondylitis (AS), where it was the sole focus for 2 studies. 10,11 In addition to AS, Mewes et al studied patients with axial SpA as well.…”

“…All 3 studies collected the retrospective 12-month fall history of patients, through the use of verbal interviews. [9][10][11] One study clearly stated their definition of a fall to be "An unintentional coming to the ground or other lower level without sustaining a violent blow, loss of consciousness, or sudden onset of paralysis, as occurs with a stroke or epileptic seizure", 10 while the remaining 2 studies did not include a fall definition. 9,11 Falls prevalence was calculated based on the number and percentage of patients who fell at least once [9][10][11] during the 12-month F I G U R E 1 PRISMA flow chart of our systematic review duration prior to the individual study durations.…”

“…The study by Mewes et al tested patients using the Berg Balance Scale (BBS) which consists of 14 tasks that assessed the participant's balance. 9 The score obtained from the BBS pre-…”

“…[9][10][11] Their increased fall risk could be attributed to various SpA disease-related factors, including poor postural balance 9,10,12 and reduced mobility. [9][10][11] Patient-related factors such as the fear of falling can also increase fall risk in SpA patients. 11 Falls and their associated complications can be debilitating, some of which include immobility, activity limitation and the fear of falling.…”