Toprak Canan Şanal, Duruöz Mehmet Tuncay, Gündüz Osman Hakan
Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey.
Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University School of Medicine, İstanbul, Turkey.
Arch Rheumatol. 2018 Jan 15;33(3):328-334. doi: 10.5606/ArchRheumatol.2018.6720. eCollection 2018 Sep.
This study aims to evaluate the static and dynamic balance disorders of patients with rheumatoid arthritis (RA) and to disclose the relationships with clinical, functional, and radiological findings of lower extremities.
A total of 81 patients with RA (15 males, 66 females; mean age 48.9±10.4 years; range 22 to 67 years) were compared with 84 age and sex-matched healthy controls (14 males, 70 females; mean age 45.9±12.1 years; range 24 to 70 years). Radiographic assessments of feet were performed to evaluate the presence of pes planus, hallux valgus, metatarsus primus varus, and splaying foot deformities. Foot functions of patients were determined with Foot and Ankle Outcome Score. The balance disorders of the subjects were evaluated with three static (modified clinical test of sensory interaction and balance, unilateral stance, weight bearing squat) and three dynamic (step-up-and-over, sit-to-stand, tandem walk) balance tests via the 'Neurocom Balance Master' device.
Rheumatoid arthritis patients had significantly higher sway velocity in unilateral stance and modified clinical test of sensory interaction and balance tests, higher step width and lower speed when walking on a line, lower rising index and higher movement time in step-up-and-over test compared to healthy controls (p<0.05). Performances on the sit-to-stand and weight bearing squat tests were comparable between both groups. Of the patients, although 61% had hallux valgus, 52% had metatarsus primus varus, 33% had pes planus, and 26% had splaying foot, these deformities were not correlated with Foot and Ankle Outcome Score or balance disorders. Presence of swollen joint was determined as the most relevant factor for balance disorders of RA patients.
Patients with RA may have increased risk for balance disorders due to cumulative effect of the lower extremity impairments seen in the course of disease.
本研究旨在评估类风湿关节炎（RA）患者的静态和动态平衡障碍，并揭示其与下肢临床、功能及影像学表现之间的关系。
共纳入81例RA患者（男性15例，女性66例；平均年龄48.9±10.4岁；年龄范围22至67岁），并与84例年龄和性别匹配的健康对照者（男性14例，女性70例；平均年龄45.9±12.1岁；年龄范围24至70岁）进行比较。对足部进行影像学评估，以评估扁平足、拇外翻、第一跖骨内翻和展性平足畸形的存在情况。采用足踝结局评分来确定患者的足部功能。通过“Neurocom Balance Master”设备，采用三项静态平衡测试（改良感觉交互与平衡临床测试、单腿站立、负重深蹲）和三项动态平衡测试（跨上一步、从坐到站、直线行走）来评估受试者的平衡障碍。
与健康对照者相比，RA患者在单腿站立和改良感觉交互与平衡测试中的摇摆速度显著更高，在线上行走时步幅更宽、速度更低，在跨上一步测试中起身指数更低、动作时间更长（p<0.05）。两组在从坐到站和负重深蹲测试中的表现相当。在患者中，尽管61%有拇外翻，52%有第一跖骨内翻，33%有扁平足，26%有展性平足，但这些畸形与足踝结局评分或平衡障碍无关。关节肿胀被确定为RA患者平衡障碍的最相关因素。
由于疾病过程中出现的下肢损伤的累积效应，RA患者可能有更高的平衡障碍风险。
