Falls, fear of falling, and associated factors in ambulatory patients with rheumatoid arthritis: A comparative study with healthy controls

Abstract

Objectives: This study aims to compare fall history and fear of falling (FOF) in patients with rheumatoid arthritis (RA) and healthy controls and to evaluate associated factors for fall risk and FOF in patients with RA. Materials and methods: Between March 2016 and July 2016, a total of 120 patients with RA and 60 age-and sex-matched healthy volunteers were included in the study. The presence of FOF (Yes/No), fall history, and the number of falls within the past 12 month were questioned. All participants were assessed with the Falls Efficacy Scale-International (FES-I), 10 Meter Walk Test (10MWT), One-Leg Stand Test (OLST), Berg Balance Scale (BBS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Pain Severity and Patient Global Assessment (PGA) by Visual Analog Scale (VAS), disability by the Health Assessment Questionnaire (HAQ), and disease activity by Disease Activity Score in 28 joints (DAS28) were evaluated in patients with RA. Results: There was no statistically difference between the RA patients and healthy controls in terms of presence of fall history, while the presence of FOF and FES-I scores were significantly higher in the RA patients (p<0.05). In the patient group, the FES-I score was positively correlated with pain VAS, PGA, DAS-28, HAQ, BAI, BDI, and 10MWT and negatively BBS and OLST (p<0.05). The number of falls, HAQ, BBS, and BDI scores were found to be significant independent risk factors affecting variations in the FES-I scores (p<0.001). Conclusion: Fear of falling seems to be an important problem in patients with RA, and patients without fall history may also have FOF. The most important factors associated with FOF were impaired balance, increased disability and depression, and number of falls in RA patients. Strategies for preventing falls, maintaining balance, improving emotional status and against FOF are of utmost importance in patients with RA.

Analysis of the Associations between Arthritis and Fall Histories in Korean Adults

“…The participants in the ‘arthritis for entire life’ and ‘current arthritis’ groups had a higher incidence (i.e., 9.4% and 10.3%, respectively) of multiple falls than those in the comparison groups in this study, which differs from previous studies involving OA (14.89%–30.1%) [ 34 , 35 , 45 ] and RA (19.0%–50.0%) [ 8 , 16 , 28 , 29 , 43 , 46 ] patients. The adjusted pORs of falling ≥ 2 times in the ‘arthritis for entire life’ and ‘current arthritis’ groups were 1.69 and 1.56, respectively.…”

“…However, few studies analyzed falls in both the RA patients and control groups, and inconsistencies exist among these studies. Two studies found no statistically significant difference in the fall rate between the RA and control groups [ 15 , 16 ]. Another study showed a higher fall rate among women with RA than among the controls (54% vs. 44%), but the difference was not significant [ 13 ].…”

“…The use of certain medications [ 8 , 19 , 28 , 29 , 31 ] and multiple medications [ 28 , 29 , 42 , 43 ] were reported as risk factors. Additionally, a history of previous diseases [ 13 , 16 , 26 , 28 ] and surgery in the lower limbs [ 8 , 15 , 31 ] were also reported. Future studies need to acquire accurate information regarding medical histories because the preceding factors can have many effects on falls.…”

“…Several previous studies reported a higher risk of falls in RA patients than in the control group, but adjustment for confounding factors was not evident. Additionally, most of the articles included a small number (<400) of patients [ 13 , 14 , 15 , 16 ], and they were based on information from participants collected before 2010 [ 13 , 14 , 15 ]. Most importantly, none of the forementioned studies stratified the groups by sex and age, and only one study included ORs data [ 17 ].…”

Aspectos socioeconômicos e eventos de queda entre idosos atendidos no sistema público de saúde

“…As fraturas mostraram ser a consequência pós-queda mais relatada pelos idosos do presente estudo. Os eventos de queda que resultam em fraturas apresentam um aumento expressivo na morbidade e mortalidade, além de terem um aspecto negativo na mobilidade do idoso (35) . As políticas de promoção da saúde socioeducativas, voltadas para a manutenção da vida através da prevenção e rastreamento de doenças, bem como as de acesso aos serviços de saúde multidisciplinares, são essenciais na melhor idade para a redução dos riscos de queda (36) .…”