评价类风湿关节炎患者下肢周围神经病变及其与跌倒风险的关系。
Evaluation of peripheral neuropathy in lower limbs of patients with rheumatoid arthritis and its relation to fall risk.
机构信息
Neurology Department, Marilia Medical School (FAMEMA), 800 Monte Carmelo Avenue, Marília, SP, 17519030, Brazil.
Physiotheraphy Departament, São Paulo State University (UNESP), 737 Hygino Muzzi Filho Avenue, Marília, SP, 17525-900, Brazil.
出版信息
Adv Rheumatol. 2022 Mar 22;62(1):9. doi: 10.1186/s42358-022-00238-3.
BACKGROUND
Rheumatoid Arthritis (RA) is a chronic disabling systemic disease characterized by joint inflammation, and extra-articular manifestations, including peripheral neuropathy, a condition that can be associated with changes in muscle strength, proprioception and postural balance contributing for the risk of falls. The objective of this study is to analyze the incidence of peripheral neuropathy in patients with RA and its association with the occurrence of falls.
METHODS
Patients were assessed by an electroneuromyography (ENMG) exam and by a questionnaire on accidental falls occurrence in the previous 12 months. They were also assessed on balance by the Short Physical Performance Battery (SPPB), functionality by the Health Assessment Questionnaire (HAQ), disease activity by the Disease Activity Score (DAS-28), neuropathic pain by the Questionnaire for the Diagnosis of Neuropathic Pain (DN4), and cutaneous sensitivity of the feet by the monofilament testing of Semmes-Weinstein. Monthly calls on falls were made in the subsequent six months. Data analysis was performed using the Shapiro-Wilk test for normality and Spearman, Chi-square, and T-student correlation tests, with a significant P level ≤ 0.05.
RESULTS
A sample of 33 patients were evaluated. The incidence of peripheral neuropathy was 48.5%, of which 68.7% were axonal and 31.3% myelinic. The sensorimotor type was present in 64.7%, motor in 17.6%, and sensorial in 11.7% of the cases. Neuropathy was associated to balance (P = 0.026), neuropathic pain (P = 0.016), deep tendon reflexes absence (P = 0,049), altered skin sensitivity of the feet (P = 0.029) and fear of falling (P = 0.001). No association was found between peripheral neuropathy and age, gender, disease activity, or functionality. No significant association was found between peripheral neuropathy and occurrence of falls, in a 12-month retrospective and 6-month prospective evaluation.
CONCLUSION
Peripheral neuropathy has a high incidence in patients with RA, and is related to neuropathic pain, altered postural balance, but not to the occurrence of falls.
背景
类风湿关节炎（RA）是一种慢性致残性系统性疾病，其特征为关节炎症和关节外表现，包括周围神经病，这种病症可能与肌肉力量、本体感觉和姿势平衡的变化有关，从而增加了跌倒的风险。本研究旨在分析 RA 患者周围神经病的发生率及其与跌倒发生的关系。
方法
通过神经肌电图（ENMG）检查和过去 12 个月内意外跌倒发生情况的问卷调查对患者进行评估。还通过简易体能状况量表（SPPB）评估平衡，通过健康评估问卷（HAQ）评估功能，通过疾病活动评分（DAS-28）评估疾病活动，通过神经性疼痛问卷（DN4）评估神经性疼痛，通过 Semmes-Weinstein 单丝测试评估足部皮肤敏感性。在随后的 6 个月内每月进行跌倒情况的电话随访。数据采用 Shapiro-Wilk 检验进行正态性分析，采用 Spearman、卡方和 t 检验进行相关性分析，显著性 P 水平≤0.05。
结果
共评估了 33 名患者。周围神经病的发生率为 48.5%，其中轴索性占 68.7%，脱髓鞘性占 31.3%。感觉运动型占 64.7%，运动型占 17.6%，感觉型占 11.7%。神经病与平衡（P=0.026）、神经性疼痛（P=0.016）、深腱反射消失（P=0.049）、足部皮肤感觉改变（P=0.029）和跌倒恐惧（P=0.001）有关。周围神经病与年龄、性别、疾病活动度或功能无关。在 12 个月的回顾性和 6 个月的前瞻性评估中，周围神经病与跌倒的发生无显著相关性。
结论
RA 患者周围神经病的发生率较高，与神经性疼痛、姿势平衡改变有关，但与跌倒的发生无关。
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