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Falls in people with rheumatoid arthritis (RA) are an underestimated problem. Almost all patients with RA develop lower extremity problems, which may increase their risk of falling because of impaired levels of physical activity, mobility and postural stability as well as diminished strength and proprioception.1 2 Only three studies have reported fall frequency in patients with RA. The annual proportion of fallers in patients with RA (mean age 59.2) ranges from 33% to 35%.1 2 3 The fall incidence rate of 0.62 falls/person-year1 is well above the fall incidence rate reported in healthy elderly people (0.45).4 5 However, all three studies used retrospective self-reports to measure fall incidence, which are likely to underestimate it.6 Prospective studies are needed for an accurate estimate of fall incidence in patients with RA and the contributing risk factors.
In this study 84 patients with RA, (59 women, 25 men, mean (SD) age 59.3 (12.0) years, range 24–86) with mean (SD) disease duration of 13.0 (10.3) years and lower extremity problems prospectively registered their falls for 1 year using monthly fall registration cards. At baseline the participants completed a fall risk assessment, including demographics, use of medication, comorbidity, visual impairment, fear of falling, history of falls in the prior year, health status (Arthritis Impact Measurement Scale (AIMS)), function (Health Assessment Questionnaire (HAQ)), balance confidence (activities-specific balance confidence (ABC) scale) and pain (visual analogue scale (VAS)).
During the study 35 patients (42%) reported a fall (range 1–9), with a fall incidence rate of 0.82 falls/person year. The fallers (n = 35) were compared with non-fallers (n = 49) for the variables of the fall risk assessment at baseline by a t test or, for the dichotomised variables, a χ2 test. Fallers did not differ from non-fallers in gender, age, disease duration, use of medication, vision, balance confidence and quality of life.
The variables that differed between the groups (p<0.10; table 1) were further analysed with backward stepwise logistic regression, with falls as dependent variable (α = 0.05). In this model, fall history and VAS pain were significant predictors of falls (OR = 9.8 and 4.8).
The high fall frequency in these moderately affected patients (mean (SD) HAQ score 1.1 (0.6))7 shows that prevention of falls in RA should receive priority. The odds for the occurrence of a fall in the coming year is almost 10 times higher in patients with RA reporting a fall in the previous year. Pain is also an important predictor. It has been suggested that this is due to a reduction in physical activity, resulting in decreased physical functioning.8 9
However, the reason why the fallers fell in the year before they monitored their fall incidents remains unknown. Therefore, causal relationships between these variables can only be speculation. Another limitation of this study is the recruitment of patients, who were invited to participate by mail. The possibility that patients with a recent history of falls were more prone to participate in the study cannot be ruled out. Nevertheless, these findings underline the need to develop fall prevention programmes for patients with RA with a history of falls to improve their mobility and independence and decrease medical costs.
Ethics approval Approved by the medical ethical board Nijmegen-Arnhem.
Provenance and peer review Not commissioned; externally peer reviewed.
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