Postural control and disability in patients with early rheumatoid arthritis

Objective Rheumatoid arthritis (RA) may affect the postural control through abnormal sensory inputs and impaired motor responses. Sensory Organization Test (SOT) objectively evaluates contribution of different sensorial afferences in postural control. The aim of the study is to assess mechanisms of postural instability and their relations with disability and disease characteristics in an early RA(ERA) cohort. Methods The equilibrium scores were assessed in 30 ERA patients and 30 age-and sex-matched controls. The somatosensory (SOM), visual (VIS) and vestibular (VEST) ratios were computed to assess the use of different sensory and the composite equilibrium score (CES) as a measure of global balance performance. Results ERA patients had lower CES (78.4 +/- 6.0% vs. 83.4 +/- 5.0%, p=0.002), SOM ratio (98.5 +/- 1.8% vs. 99.6 +/- 2.1%, p=0.035), VIS ratio (85.2 +/- 7.6% vs. 91.5 +/- 6.0%, p=0.001) and VEST ratio (70.8 +/- 10.0% vs. 80.3 +/- 7.8%, p<0.001) compared to controls. The presence of ankle arthritis correlated negatively to both SOM (r=-0.369, p=0.045) and VIS ratio (r=0.470, p=0.009), pain severity to CES (r=-0.389, p=0.045) and VIS ratio (r=-0.385, p=0.048) and HAQ-DI to CES (r=-0.591, p=0.001), SOM (r=-0.510, p=0.004) and VIS ratio (r=-0.390, p=0.033.). Patients-reported postural instability was associated with lower CES (75.4 +/- 5.4% vs. 80.7 +/- 5.5%, p=0.016) and VEST ratios (66.5 +/- 10.1% vs. 74.1 +/- 8.8%, p=0.036). SOT outcomes did not differ according to acute phase reactants, disease activity or autoantibody positivity. Conclusion RA patients showed an early impairment of postural control related to the degree of disability and subjective postural instability. Our data suggest that the lack of balance could result from both impaired motor response and abnormal sensory organisation.