Department of internal medicine, rheumatology, faculty of medical sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil.
Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil.
Ann Phys Rehabil Med. 2019 Mar;62(2):84-91. doi: 10.1016/j.rehab.2018.09.003. Epub 2018 Sep 29.
Patients with rheumatoid arthritis (RA) are at increased risk of falls, with potential adverse outcomes. There is a considerable variation across studies regarding the prevalence of falls and its correlation with clinical data, disease-related outcomes and physical performance tests.
The aim of this study was to evaluate the prevalence of falls and its association with clinical data, disease-related outcomes and physical performance tests.
In this cross-sectional study, 113 RA patients were divided into 3 groups - "non-fallers", "sporadic fallers" and "recurrent fallers" - and compared in terms of clinical data, Clinical Disease Activity Index (CDAI), lower-limb tender and swollen joint count, disability (Health Assessment Questionnaire-Disability Index [HAQ-DI]), Foot Function Index (FFI), Berg Balance Scale (BBS), Timed-up-and-go Test (TUG) and 5-Time Sit Down-To-Stand Up Test (SST5). Logistic regression analysis was performed to analyze the associations between the studied variables and the occurrence of falls, estimating odds ratios (ORs). We also analyzed the correlation between disease outcome measures (HAQ-DI and CDAI) and physical tests (BBS, TUG, SST5).
Falls and fear of falling were reported by 59 (52.21%) and 71 (64.5%) patients, respectively. Significant associations were found between "recurrent fallers" and vertigo (OR=3.42; P=0.03), fear of falling (OR=3.44; P=0.01), low income (OR=2.02; P=0.04), CDAI (OR=1.08; P<0.01), HAQ-DI (OR=3.66; P<0.01), Lower-limb HAQ (OR=3.48; P<0.01), FFI-pain (OR=1.24; P=0.03), FFI-total (OR=1.23; P=0.04), lower-limb tender joint count (OR=1.22; P<0.01), BBS score (OR=1.14; P<0.01), TUG score (OR=1.13; P=0.03) and SST5 score (OR=1.06; P=0.02). On multivariate analysis, CDAI was the only significant predictor of recurrent falls (OR=1.08; P<0.01). Physical performance test scores (BBS, TUG, SST5) were correlated with the CDAI and HAQ-DI.
The prevalence of falls in RA is high, most influenced by disease-related outcomes and linked to worse performance on physical tests (BBS, TUG and SST5).
类风湿关节炎（RA）患者跌倒风险增加，可能导致不良后果。关于跌倒的发生率及其与临床数据、疾病相关结局和身体机能测试的相关性，各研究之间存在较大差异。
本研究旨在评估跌倒的发生率及其与临床数据、疾病相关结局和身体机能测试的相关性。
本横断面研究将 113 例 RA 患者分为三组——“非跌倒组”、“偶发性跌倒组”和“复发性跌倒组”，并从临床数据、临床疾病活动指数（CDAI）、下肢压痛和肿胀关节计数、残疾（健康评估问卷残疾指数 [HAQ-DI]）、足部功能指数（FFI）、伯格平衡量表（BBS）、起立-行走计时测试（TUG）和 5 次坐-站测试（SST5）等方面进行比较。采用 logistic 回归分析研究变量与跌倒发生的相关性，估计比值比（OR）。我们还分析了疾病结局测量（HAQ-DI 和 CDAI）与身体测试（BBS、TUG、SST5）之间的相关性。
59 例（52.21%）和 71 例（64.5%）患者分别报告了跌倒和跌倒恐惧。“复发性跌倒组”与眩晕（OR=3.42；P=0.03）、跌倒恐惧（OR=3.44；P=0.01）、低收入（OR=2.02；P=0.04）、CDAI（OR=1.08；P<0.01）、HAQ-DI（OR=3.66；P<0.01）、下肢 HAQ（OR=3.48；P<0.01）、FFI-疼痛（OR=1.24；P=0.03）、FFI-总分（OR=1.23；P=0.04）、下肢压痛关节计数（OR=1.22；P<0.01）、BBS 评分（OR=1.14；P<0.01）、TUG 评分（OR=1.13；P=0.03）和 SST5 评分（OR=1.06；P=0.02）显著相关。多变量分析显示，CDAI 是复发性跌倒的唯一显著预测因素（OR=1.08；P<0.01）。身体机能测试评分（BBS、TUG、SST5）与 CDAI 和 HAQ-DI 相关。
RA 患者跌倒的发生率较高，主要受疾病相关结局影响，并与 BBS、TUG 和 SST5 等身体机能测试的表现较差相关。
