FALLS, FEAR OF FALLING AND RISK FACTORS IN ADULTS WITH RHEUMATOID ARTHRITIS:A PROSPECTIVE STUDY
Authors: E. K. Stanmore, J. Oldham, D. A. Skelton, Neill, C. Todd
Journal: Annals of the Rheumatic Diseases (2013)

Background: The risk of falls may be higher in people with RA due to muscle weakness, impaired mobility and balance, pain and joint abnormalities however there are few studies that have investigated the contribution of disease related factors alongside other potential risk factors in people with RA. In addition, Fear of falling is not limited to older people but may affect adults of all ages with RA (Yamagiwa et al., 2011; Smulders et al., 2009; Furuya et al., 2009; Jamison et al. 2003).Objectives: To determine the incidence of falls, prevalence of fear of falling and fall risk factors in adults with rheumatoid arthritis.Methods: Prospective cohort study. Patients were recruited from four outpatient clinics in the Northwest of England and followed for 1 year after clinical assessment, using monthly falls calendars and telephone calls. Risk factors for falls included lower limb muscle strength, postural stability, number of swollen and tender joints, functional status, history of falling, fear of falling, pain, fatigue and medication. Data on demographics, vision, co-morbidities, history of surgery, fractures, and joint replacements were also recorded.Results: 535 participants followed for one year had a total of 598 falls. 36.4% participants reported falling with an incidence rate of 1313/1000 person-years at risk or 1.11 falls per person. Bivariate logistic regression showed that falls risk was independent of age and gender. A history of falls in the previous one year was a strong medical fall predictor with an odds ratio (OR) for a single fall=3.3 and for multiple falls OR=4.3. Multivariate logistic regression revealed that when taken in combination with other factors, a history of multiple falls in the previous one year was the most significant predictive risk factor. The most significant modifiable risk factors were swollen and tender lower limb joints (hip, knee and ankle) (OR=1.7), psychotropic medication (OR=1.8) and increasing fatigue (OR=1.13).Conclusions: Adults of all ages with RA are at high risk of falls and fall-related injuries. High risk falls patients with RA can be identified by asking whether patients have fallen in the past year. Management of swollen and tender lower limb joints, fatigue and consideration of psychotropic medicines may be the most effective strategy to reduce falls in this group of patients. Fear of falling, pain, lower limb strength and poor balance are other useful clinical indicators that may be modified to prevent falls.References: Jamison M, Neuberger GB, Miller PA. Correlates of falls and fear of falling among adults with rheumatoid arthritis. Arthritis Rheum 2003; 49(5):673-680.Furuya T, Yamagiwa K, Ikai T, Inoue E, Taniguchi A, Momohara S, Yamanaka H. Associated factors for falls and fear of falling in Japanese patients with rheumatoid arthritis. Clin Rheum 2009; 28 (11): 1325-1330.Smulders E, Schreven C, Weerdesteyn V, Van Den Hoogen F H J, Laan R, Van Lankveld W. Fall incidence and fall risk factors in people with rheumatoid arthritis: Ann Rheum Dis 2009; 68(11):1795-1796.Yamagiwa K, Iijima S, Furuya T, Ikai T, Inoue E, Taniguchi A, Momohara S, Yamanaka H. Incidence of falls and fear of falling in Japanese patients with rheumatoid arthritis. Modern Rheumatology 2011, 21 (1):51-56.Acknowledgements: Thanks to all participants, staff at the Wellcome Trust Clinical Research Facility, Prof John Campbell, Prof I. Bruce, Dr A. Hassell, Dr S. Ryan and Dr M Pilling.