Balance and prospective falls in patients with rheumatoid arthritis

Background: Postural control is associated with fall risk. Patients with rheumatoid arthritis (RA) have a higher risk to fall than healthy subjects. The objective of this study was to identify associations between variables of postural control with prospective falls in patients with RA. Methods: For the baseline, the balance performance of 289 men and women with RA, ages 24-85 years, was evaluated by SPPB, FICSIT-4 and Romberg tests. Postural sway for Romberg, semitandem, tandem and one-leg stands were measured with the Leonardo Mechanograph (R). Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ) and the Activity-specific Balance Confidence Scale (ABC-scale). Falls were reported in quarterly reports over a year. Univariate and multiple logistic regression analysis were used to explore any associations with falling. Receiver-operating characteristics were determined, and the area under the curve is reported. Results: A total of 238 subjects completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. Age (OR = 1.04, CI 1.01-1.07), HAQ (OR = 1.62, 1.1-2.38), FICSIT-4 scoring 0-4 (OR = 2.38, 1.13-5.0), and one-leg standing (OR = 2.14, 1.06-4.31) showed significant associations with falls. With regard to the SPPB and ABC-scale, no statistically significant associations with falls were found. The quartiles containing the worst results of medio-lateral sway of Romberg (OR = 2.63, CI 1.03-6.69), total sway of semitandem (OR = 3.07, CI 1.10-8.57) and tandem (OR = 2.86, CI 1.06-7.69), and area of sway of semitandem (OR = 2.80, CI 1.11-7.08) stands were associated with falls. Conclusions: The assessment of a one-leg stand seems to be a good screening tool to discriminate between high and low risk of falls in RA patients in clinical practice. A low FICSIT-4 score and several sway parameters are important predictors of falls.