For patients with rheumatoid arthritis, characteristics of the foot and ankle are not correlated with falls, independent of previous falls, according to recent findings.
In a 12-month, prospective, observational study, researchers enrolled eligible participants from three rheumatology outpatient clinics in the Auckland region of the North Island in New Zealand. Participants were aged 18 years or older and had a diagnosis of RA according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria.
A single researcher with 5 years of podiatric assessment experience evaluated all participants in a single baseline study visit, during which the researcher recorded participant characteristics, including age, sex, ethnicity, weight, height and BMI. Researchers confirmed RA diagnoses through patient records, as well as disease duration, presence of erosive foot disease on plain radiography, prior foot surgery, blood tests, medications, and comorbidities. Fall history within the preceding 12 months was also recorded. The patients self-reported general pain, foot pain and patient global assessment of current health using a 100-mm visual analog scale (VAS). The foot and ankle assessments they made were foot type, foot problem score (FPS), plantar sensation, foot and ankle muscle strength, ankle range of motion, toe strength, gait speed, peak plantar pressure, postural instability and footwear.
The study’s primary outcome was falls experienced over the 12-months after the baseline study visit (prospective falls). Prospective falls were documented using monthly falls calendars and follow-up telephone calls. The researchers found a high prevalence of foot disease, with 62% of participants (n = 112) showing foot erosion on radiograph, 65% (n = 130) had bunion deformity, and 34% (n = 68) had pes planovalgus foot type. Seventy-three percent (n = 147) reported foot pain within the previous week with a mean 100-mm VAS score of 32.
Of the 200 participants prospectively followed, 84 (42%) fell at least once and 39 (19%) experienced multiple falls. In a bivariate analysis comparing fallers vs. non-fallers over the 12-month period, researchers observed a higher tender joint count in fallers (P = .05). Fallers also took more medications (P = .039) and had a higher likelihood of receiving anticoagulant (P = .009) and psychotropic (P = .028) medication. Patients with a history of falls had a significantly higher probability of a 1-year follow-up fall (P = .009).
Regarding foot and ankle characteristics, a greater likelihood of foot or ankle tender joints was present in fallers (P = .028) and fallers also had a greater likelihood of increased AP sway (P = .04) and ML sway (P = .042) in closed-eyes conditions. In a multivariate analysis of predictors of fall risk, researchers identified the use of psychotropic medication (OR = 2.34; P = .025) and history of falls at baseline (OR = 2.27; P = .008) as independent predictors of prospective falls.
“Disease-related impairments and reduced functioning contribute to fall risk in adults with RA,” the researchers wrote. “The current study adds to existing evidence for fall risk factors in adults with established RA.” – by Jennifer Byrne
Disclosure: The researchers report no relevant disclosures.