Background Some studies reported that patients with rheumatoid arthritis (RA) have a high risk of falls compared with healthy aged people1)2). Pain in the lower extremities and impairment in walking were reported to be associated with falls in patients with RA2)3). Orthopaedic lower limb surgeries are often performed for joint pain or deformation. After surgery, the incidence of falls might decrease, however, there were few studies about the incidences and risk factors of falls in patients with RA after lower limb surgeries.
Objectives The aims of current study were to examine the incidences of falls and to analyze the risk for falls in RA patients in association with lower limb surgeries.
Methods Self-reported questionnaires were performed for 141 patients (121 female and 20 male) who came to our hospital for regular visit from July 2010 to April 2011. Patients who underwent surgery within a year or could not walk were excluded. The incidences of falls in patients who underwent lower limb surgeries (71 cases, 115 surgeries) were compared to patients with no history of surgery (70 cases). With regard to procedures, total knee arthroplasty was performed in 44 cases, toe plasty was in 28 cases, total hip arthroplasty was in 14 cases, and others were 29 cases.
Results The incidence rate of falls in patients who underwent lower limb surgery was significantly fewer than in patients with no history of surgery (9.8% vs. 38.6%, p<0.01). Among the patients with history of surgery, Disease Activity Score (DAS) 28-CRP(4) was significantly higher in the fall group than in the no-fall group (3.53 vs. 2.68, p<0.01). Tender joint counts was also significantly higher in the fall group than in the no-fall group (2.6 vs. 1.5, p<0.05). There was no correlation between types of surgery and the frequency of falls. The frequency of falls decreased after surgery in 30% of the patients, on the other hand, it increased in 6% of the patients. As for walking ability, 34% of the patients answered that walking ability was improved after surgery, in contrast, 7% of the patients answered walking ability was impaired. Multivariate logistic regression analysis revealed that tender joint counts (Odds ratio 2.03, p<0.05) and DAS28-CRP(4) (Odds ratio 5.71, p<0.05) were significant risk factors for falls, in contrast, the history of lower limb surgery was negative risk factor (Odds ratio 0.04, p<0.01).
Conclusions The rate of falls was decreased in 30% of the patients after surgery. Also, walking ability clearly improved after surgery in 34% of the patients, which may resulted in decreased incidence of falls. Some patients had high disease activity even after surgery, which may be the reason why the frequenciy of falls increased in 6% of the patients after surgery. Tender joint counts and DAS28-CRP(4) were significant risk factors for falls, on the other hand, history of lower limb surgery was negative risk factor.
Kaz Kaz H et al. Fall-related risk factors and osteoporosis in women with rheumatoid arthritis. Rheumatology 2004 43: 1267-71
T Furuya et al. Associated factors for falls and fear of falling in Japanese patients with rheumatoid arthritis. Clin Rheumatol 2009 28: 1325-30
M Hayashibara et al. Incidence and risk factors of falling in ambulatory patients with rheumatoid arthritis: a prospective 1-year study. Osteoporos Int. 2010 21(11): 1825-33
Disclosure of Interest None Declared
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