Background Rheumatoid arthritis (RA) is a chronic disease that affects the bone and joints. Patients with RA migth be considered to be at increased risk of falls and FOF for a variety of reasons, including the presence of muscle weakness and stiff or painful joints of the lower extremities resulting in impaired physical activity, mobility, balance, and postural stability (1,2).
Objectives The aim of the present study was to compare fall history and fear of falling (FOF) in patients with RA with healthy controls, and to investigate their relationships between the demographic features, severity of pain, disability, disease activity, walking velocity, balance and emotional status in patients with RA.
Methods One hundred-twenty patients with RA and 60 healthy volunteers were included in the study. Their fall history (yes, no) and the number of falls within the last year were questioned. FOF by presence of FOF (yes/no) and by Falls Efficacy Scale-International-I (FES-I), walking time by 10 Meter Walk Test (10MWT), balance by One-Leg Stand Test (OLST) and Berg Balance Scale (BBS), emotional status by Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were performed in both groups. Pain severity and patient global assessment (PGA) by Visual Analogue Scale (VAS), disability by the Health Assessment Questionnaire (HAQ), disease activity by Disease Activity Score-28 (DAS-28) were evaluated in patients with RA.
Results There was no statistically difference between the RA patients and controls in terms of presence of fall history while presence of FOF and FES-I scores were significantly high in patients. PGA, 10MWT, pain VAS, HAQ, FES-I, BAI and BDI scores were significantly high, BBS score and OLST were significantly low fallers when compared to the non-fallers in the patients (p<0.05). In the patient group, FES-I score was significantly correlated with pain VAS, PGA, DAS-28, HAQ, BAI, BDI, 10MWT positively, and BBS, OLST negatively (p<0.05). In regression analysis; the number of falls, HAQ, BBS and BDI scores were detected to be the apparent independent risk factors affecting variations in FES-I scores (p<0.001).
Conclusions According to the results of our study, ambulatory patients with RA have increased FOF, disturbed balance, increased walking time and impaired emotional status compared with controls. On the other hand; walking time, pain severity, disability, scores of emotional status and PGA were higher, while the balance scores were lower in the RA patients with fallers. There were relationships between FOF and increased pain, high disease activity and anxiety level, impaired PGA, increased walking time but the most important factors associated with FOF were impaired balance, increased disability and depression, and number of falls in RA patients. Strategies for preventing falls, maintaining balance, improving emotional status and againts FOF are of the utmost importance in patients with RA.
Armstrong C, Swarbrick CM, Pye SR, O'Neill TW. Occurrence and risk factors for falls in rheumatoid arthritis. Ann Rheum Dis.2005;64:1602–4.
Jamison M, Neuberger GB, Miller PA. Correlates of falls and fear of falling among adults with rheumatoid arthritis. Arthritis Rheum. 2003;49:673–80.
Disclosure of Interest None declared