Background Patients with rheumatoid arthritis (RA) who have muscle weakness and stiff or painful joints might be at increased risk for falls. However, previous prospective studies have not included controls to clarify whether RA per se represents a risk factor for falls.
Objectives The present study prospectively compares the five-year incidence of falls and risk factors influencing falls between patients with RA and controls based on the findings of the TOMORROW study (UMIN000003876) that started in 2010.
Methods We compared anthropometric parameters, bone mineral density, disease activity, and the incidence of falls in 202 patients with RA (mean age, 58.6 years; medication with biological agents, 54.9%) and in 202 age- and sex-matched healthy volunteers (controls; mean age, 57.4 years) over a five-year period. We also analyzed risk factors for falls in the patients using multivariate regression analysis.
Results The rate of individuals who fell did not significantly differ between patients with RA (n=101, 50%) and Controls (n=91, 45%) within the five-year period. However, the incidence of falls was significantly higher in the patients than the controls (0.39 vs. 0.21/person-years (py); p =0.002). Multivariate linear regression analysis adjusted for fall risk factors including age, sex, smoking, and body mass index, revealed the association of a history of falls at entry into the study and RA morbidity with the number of falls in all participants (β =0.248, 0.144, p <0.01, respectively). In addition, anti-cyclic citrullinated peptide antibody (CCP), matrix metalloproteinase (MMP)-3 levels, a history of falls at entry, mean MMP-3 values, disease activity score 28 (DAS28-CRP), modified Health Assessment Questionnaire (mHAQ) score and glucocorticoid dosage (GC) over five years were related to the number of falls among the patients (Table 1).
Conclusions The rate of individuals who fell did not significantly differ between the patients and controls, but the incidence of falls was significantly higher in the patients within the five-year period. A higher titer of anti-CCP, higher doses of GC, and a high anti-CCP level were the most significantly associated with an increased frequency of falls among patients with RA.
Disclosure of Interest None declared