Background/Purpose: People with rheumatoid arthritis (RA) have an increased risk of falls. The consequences of falls include loss of confidence and independence, injury and death. The foot is a common site of pathology in RA and foot problems are reported in up to 90% of people with established disease. Previous studies in non-RA populations have identified that foot and ankle problems are associated with falls in older adults. The aim of this prospective observational study was to determine whether foot and ankle characteristics are associated with falls in people with RA.

Methods: Adults with RA according to the 2010 ACR/EULAR classification criteria were recruited from rheumatology outpatient clinics. RA characteristics, common fall risk factors, and foot and ankle variables were measured at baseline. Foot and ankle measures included deformity, joint swelling and tenderness, sensation, muscle strength, range of motion, gait speed, plantar pressures, postural stability, foot pain and self-reported foot impairment. Participants were then followed for 12 months, to record the occurrence of falls, using monthly falls calendars and telephone calls. The Prevention of Falls Network Europe (ProFaNE) definition of, “an event that results in a person coming to rest unintentionally on the ground or other lower level”, was used to identify falls. Univariate parametric and non-parametric analysis compared fallers and non-fallers on all baseline variables to determine significant differences. Logistic regression analysis identified baseline variables which were independent predictors of falls over the 12 month period. 

Results: Two hundred and one participants completed the baseline assessment and 196 (98%) completed follow-up to 12 months. Eighty-four (42%) participants fell at least once and 39 (19%) experienced multiple (>1) falls over the 12 month follow-up period. Significant baseline factors associated with falls in univariate analysis are presented in Table 1. Fallers had significantly higher tender joint count, took more medications, were more likely to take psychotropic medication or use an assistive device. Fallers also had increased postural sway with eyes closed, were more likely to have tender joints in the feet or ankles and a 12-month history of falls. In logistic regression analysis, including age and all baseline variables at a level of p<0.15 in the univariate analysis, but excluding 12-month fall history, psychotropic medication (odds ratio 2.4, p=0.03) and presence of foot or ankle tender joints (odds ratio 2.0, p=0.03) were independent predictors of falls.

Conclusion: Psychotropic medications and tender joints in the feet and ankles are independent predictors of falls in people with RA. Clinical assessment of synovitis in the feet and review of psychotropic medications may be of benefit when considering falls prevention in people with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/foot-and-ankle-characteristics-associated-with-falls-in-people-with-rheumatoid-arthritis-a-prospective-longitudinal-study/