Objectives Patients with rheumatoid arthritis (RA) who have muscle weakness and stiff or painful joints might be at increased risk for falling and fracture. The present study prospectively determines the incidence of falls, fractures, and their risk factors in patients with RA who participated in the TOMORROW study that began in 2010.
Methods We evaluated anthropometric parameters, bone mineral density, disease activity and the incidence of falls and fractures for a period of three years in 202 patients with RA (average age, 58 years; medication with biological agents, 54%) and 202 age- and sex-matched healthy volunteers (Controls, average age, 57 years).
Results The incidence of falls did not significantly differ between patients with RA (n=75, 37%) and Controls (n=61, 30%) within the three-year period. The patients with RA fell significantly more frequently than controls (2.76 vs. 1.91 falls/three years; p=0.03). After adjusting for risk factors for falls and fractures, including age, sex, smoking and body mass index, multiple regression analysis revealed that a history of falls was the most significant parameter associated with the incidence of falls (odds ratio [OR], 3.59; 95% confidence interval [CI], 1.61–8.00; p =0.002) in Controls. However, neither a history, falls nor the incidence of falls were significantly associated in patients with RA (OR, 1.93; 95% CI, 0.99–3.77; p=0.005). The total amount of glucocorticoid (GC), the average erythrocyte sedimentation rate (ESR) during the three years and anti- cyclic citrullinated peptide antibody (CCP) levels at entry were apparently related to the number of falls after adjusting for fall risk factors among the patients (GC, β=0.158; p=0.028; ESR, β= -0.211, p=0.005; CCP, β=0.295, p<0.001). Furthermore, the incidence of fractures did not differ between the patients (n=21, 9.4%) and the Controls (n=15, 7.4%) during the three-year period. After adjusting for the same risk factors described above, the incidence of falls during three years (OR, 12.9; 95% CI, 2.47–48.24; p<0.001) and GC medication at entry (OR, 4.55; 95% CI, 1.65–12.60; p =0.004) were associated with the incidence of fractures in RA patients.
Conclusions The incidence of falls and fractures did not significantly differ between patients with RA and Controls during a period of three years; however, more patients than Controls fell repeatedly. Medicating RA with GC was apparently associated with the incidence of fractures and high doses of GC were associated with an increased frequently of falls among patients with RA.
Disclosure of Interest K. Mamoto: None declared, T. Koike Grant/research support: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma,Banyu Pharmaceutical and Ono Pharmaceutical, T. Okano: None declared, Y. Sugioka: None declared, M. Tada: None declared, K. Inui Grant/research support: Chugai Pharmaceutical Co., Ltd.,Mitsubishi Tanabe Pharma Co., Astellas Pharma Inc., Abbvie GK, Eisai Co.,Ltd., MSD K.K. Speakers bureau: Bristol-Myers K.K., Takeda Pharmaceutical Corporation, Ltd., Chugai Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K.,Abbvie GK,Astellas Pharma Inc., H. Nakamura Grant/research support: Chugai Pharmaceutical Co., Ltd., Astellas Pharma Inc., Nippon Zoki Pharmaceutical Co., Ltd., Daiichi Sankyo Speakers bureau: Eisai Co.,Ltd., Daiichi Sankyo