Objectives Patients with rheumatoid arthritis (RA) who have muscle weakness and stiff or painful joints might be at increased risk of falling and vertebral fractures. The present study prospectively determines the incidence of falls and associated risk factors in patients with RA in the TOMORROW study (UMIN000003876) that started in 2010.
Methods We evaluated muscle volume, bone density, thoracolumbar spine X-rays and disease activity in 202 consecutive patients with RA (54% using biological agents) and 202 age- and sex-matched healthy individuals as controls and then assessed the incidence of falls for 2 years.
Results The incidence of having at least one fall during the 2-year period did not significantly differ between the patients and controls (29.7% vs. 26.7%, NS). However, the patients fell significantly more often than controls (2.37 vs.1.56 falls; p = 0.03) and had a higher prevalence of vertebral fractures (45.5% vs. 30%) and semiquantitative (SQ) grade ≥2 (15% vs. 5%) than the controls. After adjusting for risk factors of falls such as age, gender, smoking and BMI, multiple logistic regression analysis identified that a history of falls was the most significant parameter associated with the incidence of falls (odds ratios: all, 2.44, p < 0.001; patients, 2.40, p = 0.014; controls, 2.72, p = 0.015; Table 1). Existing vertebral fractures and SQ grade ≥2 did not correlate with the incidence of falls (Table 1). Multiple regression analysis revealed that the number of falls experienced by patients with RA was associated with doses of prednisolone (PSL; β = 0.188, P = 0.010,) and matrix metalloproteinase-3 (MMP-3; β = 0.156, P = 0.028).
Conclusions A history of falls was an independent risk factor for any fall in all participants. Patients with RA receiving high doses of PLS or MMP-3 tended to fall more frequently than healthy individuals.
Disclosure of Interest K. Mamoto: None Declared, T. Koike Speakers bureau: akeda Pharmaceutical, Mitsubishi, T. Okano: None Declared, Y. Sugioka: None Declared, M. Tada Grant/research support from: Japan Osteoporosis Foundation grant 2013, K. Inui: None Declared, H. Nakamura: None Declared