Objectives Patients with rheumatoid arthritis (RA) who have muscle weakness and stiff or painful joints might be at increased risk of falls. The present study prospectively determined the incidence of falls and risk factors in patients with RA who participated in the TOMORROW study (UMIN000003876) that began in 2010.
Methods We evaluated anthropometric parameters, bone mineral density, disease activity and the incidence of falls for a period of 4 years in 202 patients with RA (mean age, 58.6 years; medication with biological agents, 54.9%) and 202 age- and sex-matched healthy volunteers (Controls; mean age, 57.4 years).
Results The incidence of falls did not differ significantly between patients with RA (n=96, 47.5%) and Controls (n=82, 40.6%) within the 4-year period. However, patients with RA fell significantly more frequently than controls (1.39 vs. 0.83 falls/4 years; p <0.05). After adjusting for risk factors for falls, including age, sex, smoking and body mass index, multiple regression analysis revealed history of falls as the parameter most significantly associated with incidence of falls (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.54–6.16; p =0.01) in patients with RA. Furthermore, anti-cyclic citrullinated peptide antibody (CCP) and matrix metalloproteinase (MMP)-3 levels at entry and mean values for MMP-3, modified Health Assessment Questionnaire (mHAQ) score and glucocorticoid dosage (GC) over the 4 years were apparently related to the number of falls after adjusting for fall risk factors among patients (CCP, β =0.294; p <0.005; MMP-3 at entry, β =0.184, p =0.008; mean MMP-3, β =0.149, p =0.042; mean mHAQ, β =0.151, p =0.044; mean GC, β =0.154, p =0.029).
Conclusions Incidence of falls did not differ significantly between patients with RA and Controls during a 4-year period, but more patients than Controls fell repeatedly. High levels of CCP and high doses of GC appear significantly associated with an increased frequency of falls among patients with RA.
Disclosure of Interest K. Mamoto: None declared, K. Inui: None declared, T. Okano: None declared, Y. Sugioka: None declared, M. Tada: None declared, T. Koike Grant/research support from: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, H. Nakamura: None declared