Background Patients with rheumatoid arthritis (RA) have impaired levels of physical activity and postural stability, so we can suggest that they have increased risk of falls. RA-patients also have a higher risk of osteoporosis (OP). OP and falls lead to fractures, which contribute significantly to morbidity and mortality of these patients.
Objectives In prospective study evaluate the frequency of falls and fractures in RA patients.
Methods We performed 1 year prospective observational study of RA patients (n=108 and mean age 62.5±7.1years old) and people without RA (n=92 and mean age 63.3±7.1years old). The participants completed risk factors questionnaire, Health Assessment Questionnaire (HAQ), EuroQol-5D (EQ-5D) and performed Short Physical Performance Battery (SPPB). Disease activity and intensity of pain were assessed in RA patients with DAS28 and VAS. Bone density (BMD) was measured in lumbar spine and proximal hip using dual-energy X-ray absorptiometry (Hologic Discovery A) in all participants.
Results At baseline visit more RA patients had a history of previous fall during 1 year before the study compared with controls (27% vs 17%, p>0.05). RA patients had atraumatic fractures at younger age than control (55±15 vs 66±20 years old), they were more fearful of falling and had abnormal SPPB test (p<0.05), especially in performing gait speed test and chair stand test (p<0.05), but no difference among 2 groups in performing balance test. RA women complained on insomnia more often than control (p<0.05). RA patients spent time outdoors especially in the winter significantly rarely than control. During the next year 26 (24%) RA patients and 11(12%) persons without RA had at least one fall (p=0.028). No differences among fallers of two groups in age, number of comorbid conditions. Among RA patients fallers did not differ from non-fallers in age, disease duration, use of medications (except glucocorticosteroids), visual acuity. RA fallers had significantly higher DAS28, pain intensity, received higher daily dose of glucocorticosteroids (p=0.04), had less EQ-5D on baseline visit, and more often fell the year before screening. At least in one of measured areas low BMD was found out in 70% RA-fallers, but only 42% of patients received OP treatment. High risk of fractures estimated by FRAX was found in 69% RA-fallers. 7 (27%) RA-fallers had atraumatic fracture during the next year: 86% - were with OP, 57% - had fractures in the past, 71% - FRAX high fracture risk, at the same time only 43% received OP treatment.
Conclusions RA patients had a high risk of falling and fractures, so it is necessary to consider these patients as candidates for earlier treatment and rehabilitation programs to reduce that risk.
Disclosure of Interest None Declared