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Abstract Number: 396

The Dosage Of Prednisolone Is a Risk Factor For Falls In Rheumatoid Arthritis Patients -The Third Year Results Of The Tomorrow Study-

Yuko Sugioka1, Tatsuya Koike2, Kenji Mamoto1, Tadashi Okano1, Masahiro Tada1, Kentaro Inui3 and Hiroaki Nakamura1, 1Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan, 2Rheumatosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan, 3Orhtopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Fall Risk, prednisolone, prednisone and rheumatoid arthritis (RA)

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Session Information

Session Title: Rheumatoid Arthritis - Clinical Aspects I: Comorbidities in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

 Background/Purpose: Population-based studies suggest an association between musculoskeletal problems and an increased risk of falls. Patients with rheumatoid arthritis (RA) who have muscle weakness and stiff or painful joints might be at an increased risk of falling. But, no prospective cohort study concerning fall incidence in RA has been performed. This study used a prospective cohort design to determine the incidence of falls and to elucidate their risk factors in patients with RA who participated in the TOMORROW study (UMIN000003876) that was started in 2010.

 Methods: We have started the TOMORROW study examining several risk factors affecting RA. The participants in the study consist of 202 RA patients (109 patients receiving biological agents) and 202 age-and sex-matched healthy volunteers were collected through mass media as controls. As a baseline, all participants completed a self-administered questionnaire on general health status. Laboratory data and anthropometric parameters were also collected. Body composition was determined by whole body dual X-ray absorptiometry. Vertebral fractures using thoracolumbar spine X-rays were evaluated. In addition, incidence of falls was tracked with a “fall calendar” for 3 years and we collected the calendar yearly.

Results: The incidence of having at least one fall during the 3-year period did not significantly differ between the patients and controls (37.1% vs. 30.2%, NS). However, the patients fell significantly more often than controls (2.48 vs.1.74 falls; p = 0.03) and had a higher prevalence of vertebral fractures (46% vs. 30%) and semiquantitative (SQ) grade ≥2 (15% vs. 5%) than the controls. After adjusting for risk factors of falls such as age, gender, smoking and BMI, multiple logistic regression analysis identified that a history of falls was the most significant parameter associated with the incidence of falls (odds ratios: all, 2.49, p < 0.001; patients, 1.98, p = 0.047; controls, 3.60, p = 0.017). Existing vertebral fractures and SQ grade ≥2 did not correlate with the incidence of falls. Multiple regression analysis revealed that the number of falls experienced by patients with RA was associated with the dosage of prednisolone (PSL; β = 0.214, P = 0.027,) and matrix metalloproteinase-3 (MMP-3; β = 0.141, P = 0.046) (Table 1.).

Conclusion: We evaluated the associated risk factors for falls in RA patients. Multiple falls in RA patients were significantly higher than in controls over the past three years. In RA patients, history of fall and a prednisolone use were associated with falls. The patients who fell at least once tend to fall again. To prevent falls, various interventions are necessary for the patients.

Table 1. Association between number of falls and parameters adjusted for potential confounders for falls.

Multivariate

RA patients

 

number of falls

β

P value

mHAQ

0.071

0.347

Prednisolone  (PSL: mg/day)

0.214

0.027

MMP-3

0.141

0.046

Whole BMD (mg/cm2)

-0.020

0.843

Body fat (kg)

0.181

0.201

Walking period(min/day)

0.044

0.535


Disclosure:

Y. Sugioka,
None;

T. Koike,

Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical,

8;

K. Mamoto,
None;

T. Okano,
None;

M. Tada,

Japan Osteoporosis Found grant 2013,

2;

K. Inui,
None;

H. Nakamura,
None.

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