Article abstract


Introduction: we aimed to analyze the prevalence of fall, fear of falling and risk of falls in the patients with rheumatoid arthritis and the associated factors.

 

Methods: one hundred and twenty-three participants with rheumatoid arthritis (RA) aged over 18 years were enrolled based on the 1987 ACR/EULAR classification criteria. Patients were asked to complete an interviewer-assisted questionnaire about the number of falls and fear of falling during the last 12 months. Comorbidities and complications related to the disease were also obtained. The disease activity was evaluated by the patient and evaluator global assessment (PGA, EGA), the tender and swollen joint counts (TJC28, SJC28), the disease activity Score 28 ESR (DAS28 ESR) and the clinical and simple disease activity indexes (CDAI, SDAI). The functional disability was measured by the health assessment questionnaire (HAQ). The risk of falls was estimated by five standardized performance tests: the Tinetti test (TIT), the timed get up and go test (TUG), the chair-rising test (CRT), the tandem and the tandem stand tests. The relation between disease parameters and the test of fall were analyzed by the r of Pearson, Spearman and Chi-square. The factors associated with falls and fear of falls were evaluated using multiple linear regression analysis and t independent test.

 

Results: twenty-three (18.7%) participants reported a fall and forty-five (36.6%) of them the fear of falls. Risk of falls was strongly correlated with age (CRT: r = 0.345, TIT: r = -0.314), TJC 28 (TIT: r = -0.482, TUG: r= 0.260), PGA (TIT: r = -0.481, TUG: r = 0.375) EGA (CRT: r = 0.27, TIT: r = -0.48), DAS28 ESR (CRT: r = 0.32, TUG: r = 0.25, TIT: r = -0.51), CDAI (TIT: r = -0.421, TUG: r = 0.292), HAQ (CRT: r = 0.411, TIT: r = -0.648, TUG: r = 0.537) and disease duration (CRT: r = 0.343, TIT: r = -0.400, TUG: r = 0.363). No relation was found between corticosteroid use and the risk of falls. Fear of falls was related in simple analysis to the presence of a comorbidity (p = 0.002 OR: 0.252 CI [0.104-0.611]), the walk with aid (p = 0.010 OR: 0.1225 CI[0.025-0.602]), the body mass index (BMI) (p < 0,001 OR:1.143 CI[1.064-1.228]), the disease duration (p < 0.001 OR:3.69 CI[1.97-6.92]), the VAS pain (p = 0.001 OR:1.03 CI[1.011.05]) and the HAQ (p < 0.001 OR: 3.69 CI[3.69-6.92]). In multiple regression analysis, fear of falls remained related to BMI, HAQ and disease duration.

 

Conclusion: the falls in RA seems to be frequent. Several factors were associated to a high risk of falls and fear of falling: disease duration, HAQ and especially the high disease activity, which is the case of many patients in African countries. These results suggest that the physician has to be aware of the high risk of falling in RA patients and the importance of identifying them with a simple interrogation and physical examination.