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Characterization of falls in adults with established rheumatoid arthritis and associated factors

Characterization of falls in adults with established rheumatoid arthritis and associated factors Background: Rheumatoid arthritis patients may have an increased risk of falls due to changes caused by the disease such as muscle weakness, joint impairment, reduced mobility and postural instability. The aim of this study was to prospectively analyze the occurrence of falls in RA patients and its risk factors. Methods: A cohort of 86 RA patients were assessed over 1 year for disease activity using the Disease Activity Score (DAS-28), for functionality using the Health Assessment Questionnaire (HAQ), for the characterization of falls and for the use of medications, and they were subjected to the Berg Balance Scale (Berg), Timed Up and Go (TUG), 6- Minute Walk (6MWT) and Short Physical Performance Battery (SPPB) tests. The Kolmogorov-Smirnov, Spearman’s correlation, Student’s t, Mann-Whitney and chi-square tests were performed with a significance level of P ≤ 0.05. Results: A total of 86 patients were evaluated, of which 48.8% had at least one fall and 75.6% reported having a fear of falling. No association of falls with age, disease duration, functional capacity, disease activity or physical performance was found. Patients with poorer performance in the physical tests had more functional impairment, higher disease activity and more advanced age. No differences in physical or functional performance, disease activity, gender or fear of falling were found between fallers and non-fallers; only a greater amount of medications used was found in the group of fallers. Conclusions: The occurrence of falls was high and associated with a previous history of falls and polypharmacy, with no association with disease activity or duration, functional capacity, physical performance, age or gender. Keywords: Postural balance, Physical aptitude, Rheumatoid arthritis, Accidental falls Background prospective studies have shown associations with altered Falls have a multifactorial etiology in the elderly, mainly balance, use of psychotropic medications, fear of falling due to intrinsic factors such as decreased muscle and previous falls [4–8]. However, findings regarding strength, balance deficits, and gait pattern changes. several other risk factors, the characterization of falls These age-related changes can also be observed in other and the consequences of falls in RA patients are still diseases [1–3]. scarce or contradictory. Rheumatoid arthritis (RA) is a chronic systemic in- The aim of this study was to prospectively analyze the flammatory autoimmune disease of joint predominance, occurrence of falls in RA patients for 1 year and to in- with a high prevalence of falls occurring in 14.3 to 54% vestigate whether physical fitness and balance tests, of patients over a one-year period, which are high values medication use, previous history of falls, disease activity compared to the general population [4–19]. This in- and functionality are associated with falls. creased risk of falls may be due to pain, edema, deform- ities, loss of muscle strength or gait changes, and Methods Sample * Correspondence: maalmeida1@terra.com.br A prospective study based on the sample of a previous Marília School of Medicine, R. Pedro Martins, 209. Marília/SP – Brazil, Marília, São Paulo CEP 17519-430, Brazil retrospective study composed of 99 patients diagnosed © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Lourenço et al. Advances in Rheumatology (2018) 58:16 Page 2 of 6 with RA was conducted at the Rheumatology outpatient performed five times with the arms crossed in front of clinic of the Marília School of Medicine [19, 20]. the chest, and time is also recorded in seconds [28, 29]. Adults with a diagnosis of RA according to the The Timed Up and Go Test (TUG) was used to assess American College of Rheumatology (ACR) classifica- body balance and risk of falls, especially in the elderly. tion criteria of 1987 and/or the 2010 ACR/EULAR The test begins with the patient sitting on a chair, then (European League Against Rheumatism) RA classifica- getting up, walking a three-meter distance, making a tion criteria were included [21]. Patients with cogni- 180° turn, returning and sitting on the same chair. The tive impairments precluding them from answering the different lengths of time spent indicate the following: questionnaires, using a wheelchair or with other phys- ≤10 s - elderly without balance alteration and with low ical disabilities that impeded the execution of the risk of falls; between 10 and 20 s - elderly with no sig- tests were excluded. nificant balance alteration but presenting some weakness The study was approved by the Research Ethics Com- and medium risk of falls; and ≥ 20 s - elderly with a high mittee of the Marília School of Medicine, protocol risk of falls [30]. Other studies consider a higher risk of CAAE: 22845513.3.0000.5413. All participants signed falls between 10 and 14 s [24, 31, 32]. the informed consent form. The 6-Minute Walk Test (6MWT) was used to assess functional capacity and exercise tolerance through the distance an individual is able to walk on a hard, flat sur- Procedure face for 6 min. In healthy adults, the reference values are The rheumatologist confirmed the RA diagnosis and 580 m for men and 500 m for women [33, 34]. performed the measurements to assess disease activity, and the nurse collected the blood samples. Next, the an- thropometric data were measured, and the functional Statistical analysis questionnaires and physical tests were applied by the The Kolmogorov-Smirnov (KS) test was used to evaluate nurse and the physical therapist. the normality of the data distribution. Values were From the initial evaluation, the patients were followed expressed as the mean and standard deviation (SD) for up for 1 year by quarterly telephone contact to record variables with normal distribution and as the median the occurrence of falls and their characteristics. After and percentages for the others. Correlations were ana- 12 months, the disease activity and functionality assess- lyzed using Spearman’s test, and other analyses were ments and physical tests were repeated. conducted using Student’s t-test, the Mann-Whitney U-test and chi-square tests with a significance level of p < 0.05. The statistical program used was SPSS v.21 Instruments (IBM Armonk, NY, USA, 2012). Patients were assessed for disease activity using the Dis- ease Activity Score (DAS-28) [21], for functional cap- acity using the Health Assessment Questionnaire (HAQ) Results [22, 23] and for the occurrence of falls using a fall A total of 99 patients were included in the study, but 13 characterization questionnaire [19, 20]. were lost – three died, three had medical follow-up unit The following physical tests were performed: changes, three were not found, two were bedridden, one The Berg Balance Scale was used to determine risk refused to participate, and one suffered an ankle sprain factors for loss of independence and falls in the elderly. – leaving 86 patients. The majority of the sample con- The scale has 14 items common to daily life, scored sisted of white married women with a mean age of 55 ± from 0 to 4, with a higher fall risk associated with lower 11.8 years (Table 1). scores. The predictive value of falls in the elderly ranges There were 67 fall episodes in the one-year follow-up from 45 to 48 [24–27]. period; 48.8% of these patients fell at least once, and The Short Physical Performance Battery (SPPB) was 75.6% reported the fear of experiencing a fall episode. used to assess standing balance, walking ability and Falls occurred most often at home (58.2%), in the morn- sit-to-stand performance. The three items are scored ing (41.8%), while the patients walked (65.7%) and due from 0 to 4, with poorer physical function associated to tripping and slipping (65.5%), and fracture occurred with lower scores. Standing balance is evaluated in three in three falls (4.4% of the total). positions with progressive difficulty - feet together, with No association was found between the number of falls the hallux leaning against the medial edge of the oppos- and age, disease duration, functional capacity, disease ac- ite heel and with the hallux leaning against the posterior tivity or physical performance. Patients with poorer per- edge of the opposite heel. Walking is evaluated by meas- formance on the physical tests had more functional uring time, in seconds, for a distance of four meters. In impairment, higher disease activity and advanced age. the sit-to-stand evaluation using a chair, the action is The higher disease activity was associated with poorer Lourenço et al. Advances in Rheumatology (2018) 58:16 Page 3 of 6 Table 1 Characteristics of the sample of patients with rheumatoid arthritis Participants, n 86 Women, n (%) 76 (88.4) Age (years), mean ± SD (min-max) 55 ± 11.8 (23–88) BMI (kg/m ), mean ± SD (min-max) 27.7 ± 5.3 (15.35–40.04) Self-reported ethnicity, n (%) White 54 (62.8) Mixed 20 (23.3) Black 12 (14) Marital status, n (%) Married 52 (62.8) Single 14 (16.3) Divorced 10 (11.6) Widowed 8 (9.3) Duration of disease (years), median (P25–75) (min-max) 10 (5–16.5); (2–40) Self-reported associated diseases (%) HBP 53.5 Osteoporosis 17.4 DM 12.6 Labyrinthitis 11.6 HF 8.1 Fibromyalgia 7.0 Hypothyroidism 7.0 Depression 3.4 Falls in the previous year (%) 37.4 Walking aids (%) 9.3 n: number; %: percentage; SD: standard deviation; min: minimum; max: maximum; BMI: body mass index; kg: kilogram; m : square meter; P25–75: 25th percentile and 75th percentile; HBP: high blood pressure; DM: diabetes mellitus; HF: heart failure physical performance, poorer functional capacity and regarding physical or functional performance, disease ac- longer disease duration (Table 2). tivity, gender or fear of falling (Tables 4 and 5). The There was no significant difference in functional cap- number of medications used and history of falls differed acity or disease activity in the initial evaluation and after significantly between fallers and non-fallers (Table 5). 1 year. However, in the physical tests, better perform- ance was observed in the final evaluation when com- Discussion pared to the initial evaluation (Table 3). The incidence of falls in this sample of RA patients When divided into groups according to the occurrence was high (48.8%) compared to that found in the lit- of falls, considering fallers as patients with at least one erature, which shows ranges from 14.3 to 54% in fall episode during the follow-up period, no significant retrospective studies and from 18.8 to 50% in pro- differences were found between fallers and non-fallers spective studies [4–9, 11–19]. The incidence of falls Table 2 Correlations between the number of falls with clinical variables and functional tests Number of falls, r (P) Age, r (P) HAQ, r (P) DAS28, r (P) Age 0.059 (0.592) – − 0.109 (0.317) 0.034 (0.755) RA duration − 0.077 (0.483) 0.187 (0.087) 0.066 (0.550) 0.224 (0.039)* HAQ 0.151 (0.165) −0.109 (0.317) – 0.468 (0.000)* DAS28 0.004 (0.973) 0.034 (0.755) 0.468 (0.000)* – Berg −0.127 (0.244) −0.367 (0.001)* − 0.541 (0.000)* −0.422 (0.000)* 6MWT −0.124 (0.260) −0.244 (0.024)* − 0.495 (0.000)* −0.294 (0.006)* TUG 0.064 (0.558) 0.243 (0.025)* 0.557 (0.000)* 0.363 (0.001)* SPPB −0.121 (0.266) −0.291 (0.007)* − 0.658 (0.000)* −0.404 (0.000)* RA: rheumatoid arthritis; HAQ: Health Assessment Questionnaire; DAS28: Disease Activity Score 28; Berg: Berg Balance Scale; 6MWT: 6-min walk test; TUG: Timed Up and Go; SPPB: Short Physical Performance Battery; r: Spearman’s correlation; P: significance level Lourenço et al. Advances in Rheumatology (2018) 58:16 Page 4 of 6 Table 3 Initial and final scores on physical, functional and disease activity tests Initial Final P HAQ, median (P25–75) 0.62 (0.12–1.25) 0.62 (0.12–1.37) 0.318 DAS28, mean (±SD) 3.40 (±1.17) 3.58 (±1.32) 0.215 6MWT (meters), mean (±SD) 391.27 (±103.78) 429.52 (±129.01) 0.001 Berg, median (P25–75) 53 (49.75–56) 55 (50.75–56) 0.019 TUG (seconds), median (P25–75) 8.89 (7.59–11.69) 8.75 (7.14–11.28) 0.071 SPPB, median (P25–75) 10 (8–12) 11 (9–12) 0.001 HAQ: Health Assessment Questionnaire; DAS28: Disease Activity Score 28; 6MWT: 6-min walk test; Berg: Berg Balance Scale; TUG: Timed Up and Go; SPPB: Short Physical Performance Battery; P25–75: 25th percentile and 75th percentile; SD: standard deviation; P: t test significance level observed was also high compared to that of non- The history of falls was associated with the occurrence institutionalized elderly individuals, which ranges from of new falls, which indicates the need for special atten- 15.9 to 56.3% [2]. Although age is an important risk factor tion in the evaluation of RA patients who have already for falls, the association between falls and advanced age fallen [4, 6, 7, 36]. was not observed in this sample, which is in agreement Most of the sample presented moderate disease activ- with previous RA studies [4–6, 12, 15, 35]. ity, which, similar to the study by Bohler et al. [12], was Comparing fallers with non-fallers, there was again associated with poorer performance in most physical agreement with other RA studies but a difference from tests, but not the occurrence of falls. Koerich et al. [40] what occurs in the elderly - there was no predominance argued that the level of disease activity may influence of falls among females. It is possible that no difference physical performance (Berg and TUG), suggesting an in- was observed between men and women because both creased risk of falling or dependence in performing ac- genders have decreased muscle mass and similar pat- tivities of daily life. The lack of association between poor terns of medication consumption [5–7, 15, 35]. physical performance and disease activity with the pres- The use of several medications may increase the oc- ence of falls may be related to the time of evaluation, currence of falls due to interactions between medica- which usually occurs at the beginning or end of the tions or their side effects. In the present study, we study and not at the time of the falls. Another reason- found a significant difference between fallers and able explanation is that the increased disease activity re- non-fallers in relation to polypharmacy. Armstrong et sults in restriction of activities and therefore reduces the al. [15] reported an association between a higher num- individuals’ exposure to situations with a risk of falls. ber of medications and a higher risk of falling, while Other studies have indicated functional disability as a Stanmore et al. [36] found that using four or more risk factor for falls, but in our study, although it was as- medications more than doubles the risk of falling in RA sociated with poorer performance in physical tests, it patients. An association has also been found between was not correlated with falls [4, 9, 12, 13, 19, 20, 35]. In falls and the use of medications such as antihyperten- a prospective study with 80 patients in Japan, Hayashi- sives, diuretics, sedatives, antidepressants and antipsy- bara et al. [6] found no relationship between functional chotics [6, 8, 15, 36–39]. disability and the presence of falls and explained that the Table 5 Differences between number of medications, history of Table 4 Differences between disease activity and physical and falls, gender and fear of falling between fallers and non-fallers functional performance in fallers and non-fallers Occurrence Fallers (n = 42) Non-fallers (n = 44) Test P of falls (n) HAQ 0.81 (0.22–1.75) 0.50 (0.12–1.34) U = 763.5 0.164 No Yes χ P DAS28 3.70 (±1.49) 3.47 (±1.16) t = −0.798 0.427 Polypharmacy Up to three medications 20 9 5.55 0.018 6MWT 376.31 (±100.74) 405.88 (±105.79) t = 1.320 0.190 Four or more 24 33 Berg 53 (47.75–55.25) 54.5 (50–56) U = 787 0.229 History of falls Yes 10 22 8.087 0.004 TUG 9.27 (7.89–11.62) 8.73 (7.35–12.08) U = 852 0.660 No 34 20 SPPB 10 (7.75–11) 10.5 (9–12) U = 784.5 0.219 Gender Female 38 38 0.354 0.552 HAQ: Health Assessment Questionnaire; DAS28: Disease Activity Score 28; Male 6 4 6MWT: 6-min walk test; Berg: Berg Balance Scale; TUG: Timed Up and Go; Fear of falling Present 31 31 0.120 0.729 SPPB: Short Physical Performance Battery; P: significance level; t: t test; U: Mann-Whitney U-test Absent 13 11 Values are expressed as the mean (± standard deviation) or median (25th - 75th percentile) X : chi-square; P: significance level Lourenço et al. Advances in Rheumatology (2018) 58:16 Page 5 of 6 findings were due to the fact that five of the eight HAQ Ethics approval and consent to participate The study was approved by the Research Ethics Committee of the Marília categories assess the function of the upper limbs. School of Medicine, protocol CAAE: 22845513.3.0000.5413. All participants Although the physical tests used in the present study signed the informed consent form. are aimed at the elderly population, RA patients may Consent for publication present an early decrease in muscle strength, physical Not applicable. activity and balance in a pattern similar to that of elderly individuals, anticipating the risks resulting from the Competing interests The authors declare that they have no competing interests aging process. This may explain the finding that per- formance on physical tests was correlated with age: the Publisher’sNote older the patient, the poorer the physical performance. Springer Nature remains neutral with regard to jurisdictional claims in Although the four physical tests were significantly corre- published maps and institutional affiliations. lated among themselves, no significant association was Received: 14 May 2018 Accepted: 13 July 2018 found between any of the tests and the occurrence of falls. While some studies found an association between poorer performance on physical tests and a greater oc- References 1. Pinho TAM, Silva AO, Tura LFR, Moreira MASP, Gurgel SN, Smith AAF, et al. currence of falls or risk of falling, others found no such Avaliação do risco de quedas em idosos atendidos em Unidade Básica de association [6, 11, 12, 16, 19, 36, 37]. The lack of Saúde. Rev Esc Enferm USP. 2012;46(2):320–7. standardization in the choice of tests for the RA popula- 2. Sandoval RA, Sá ACAM, Menezes RL, Nakatani AYK, Bachion MM. Ocorrência de quedas em idosos não institucionalizados : revisão sistemática da tion may be an important factor to be considered when literatura. Rev Bras Geriatr Gerontol. 2013;16(4):855–63. analyzing these results, a gap that was observed by San- 3. Oliveira AS, Trevizan PF, Bestetti MLT, Melo RC. Fatores ambientais e risco de tana et al. [41]. quedas em idosos: revisão sistemática. Rev Bras Geriatr Gerontol. 2014;17(3): 637–45. Several studies suggest that prospective studies be 4. Smulders E, Schreven C, Weerdesteyn V, van den Hoogen FHJ, Laan R, Van conducted to minimize memory bias [13–15, 19]. Cum- Lankveld W. Fall incidence and fall risk factors in people with rheumatoid mings et al. [42], in a prospective, 12-month study of the arthritis. Ann Rheum Dis. 2009 [cited 2013 may 23];68(11):1795–1796. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19822719. elderly, found that 13–32% of the participants who fell 5. Stanmore EK, Oldham J, Skelton DA, O’Neill T, Pilling M, Campbell AJ, et al. did not report the episode at the end of the evaluation Fall incidence and outcomes of falls in a prospective study of adults with period. The follow-up strategies used were calendars, rheumatoid arthritis. Arthritis Care Res (Hoboken). 2013;65(5):737–44. 6. Hayashibara M, Hagino H, Katagiri H, Okano T, Okada J, Teshima R. journals, fall log cards and self-reports to the researcher Incidence and risk factors of falling in ambulatory patients with rheumatoid at the time of the fall. The present study has a methodo- arthritis: a prospective 1-year study. Osteoporos Int. 2010 [cited 2013 may logical advantage, as it obtained the information quar- 23];21(11):1825–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/ terly by telephone, which improved the reliability of the 7. Bugdayci D, Paker N, Rezvani A, Kesiktas N, Yilmaz O, Sahin M, et al. report of falls and facilitated detailed clarification regard- Frequency and predictors for falls in the ambulatory patients with ing the characteristics [4–8, 36]. rheumatoid arthritis: a longitudinal prospective study. Rheumatol Int. 2013 Apr;33(10):2523–7. 8. Brenton-Rule A, Dalbeth N, Bassett S, Menz HB, Rome K. The incidence and risk factors for falls in adults with rheumatoid arthritis: a systematic review. Conclusions Semin Arthritis Rheum. 2015;44:389–98. 9. Kaz Kaz H, Johnson D, Kerry S, Chinappen U, Tweed K, Patel S. Fall-related The occurrence of falls in RA patients is high and is as- risk factors and osteoporosis in women with rheumatoid arthritis. sociated with a previous history of falls and polyphar- Rheumatology (Oxford). 2004;43(10):1267–71. Available from: https:// macy, showing no association with disease activity or academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/ keh304 duration, functional capacity, physical performance, age 10. Pereira IA, Mota LMH, Cruz BA, Brenol CV, Fronza LSR, Bertolo MB, et al. or gender. In addition, the performances in the physical Consenso 2012 da Sociedade Brasileira de Reumatologia sobre o manejo de tests were associated with each other, and a poorer phys- comorbidades em pacientes com artrite reumatoide. Rev Bras Reum. 2012; 52(4):474–95. ical condition was related to greater disease activity, 11. Duyurçakit B, Nacir B, Erdem HR, Karagoz A, Saraçoglu M. Fear of falling, fall poorer functional capacity and older age. risk and disability in patients with rheumatoid arthritis. Turk J Rheumatol. 2011;26(3):217–25. 12. Böhler C, Radner H, Ernst M, Binder A, Stamm T, Aletaha D, et al. Funding Rheumatoid arthritis and falls: the influence of disease activity. A Master’s degree fellowship from Coordenação de Aperfeiçoamento de Rheumatology (Oxford). 2012 [cited 2013 may 23];51(11):2051–2057. Pessoal de Nível Superior (CAPES). Available from: http://www.ncbi.nlm.nih.gov/pubmed/22879462. 13. Marques WV, Cruz VA, Rêgo J, Silva NA. Influência da capacidade funcional no risco de quedas em adultos com artrite reumatoide. Rev Bras Reum. Authors’ contributions 2014;54(5):404–8. The rheumatologist (MRA) confirmed the RA diagnosis and performed the 14. Fessel KD, Nevitt MC. Correlates of fear of falling and activity limitation measurements to assess disease activity, and the nurse (FVBOC) collected the among persons with rheumatoid arthritis. Arthritis Care Res. 1997;10(4): blood samples. Next, the anthropometric data were measured, and the 222–8. functional questionnaires and physical tests were applied by the nurse and the 15. Armstrong C, Swarbrick CM, Pye SR, O’Neill TW. Occurrence and risk factors physical therapist (MAL). All authors read and approved the final manuscript. for falls in rheumatoid arthritis. Ann Rheum Dis. 2005;64(11):1602–4. Lourenço et al. Advances in Rheumatology (2018) 58:16 Page 6 of 6 16. Jamison M, Neuberger GB, Miller PA. Correlates of falls and fear of falling rheumatoid arthritis. Clin Rheumatol. 2009 Nov [cited 2013 may 23];28(11): among adults with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2003; 1325–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19618097. 49(5):673–80. 40. Koerich J, Armanini KK, Iop RR, Borges Júnior NG, Domenech SC, Gevaerd 17. Schober HC, Maass K, Maass C, Reisinger EC, Schröder G, Kneitz C. Value of MS. Avaliação do equilíbrio corporal de pacientes com artrite reumatoide. fall-risk tests for patients with rheumatoid arthritis. Z Rheumatol. 2011;70(7): Fisioter e Pesq. 2013;20(4):336–42. 609–14. 41. De Santana FS, Nascimento DDC, De Freitas JPM, Miranda RF, Muniz LF, 18. Sugioka Y, Koike T. Fall risk and fracture. Associated factors for falls in Santos Neto L, et al. Avaliação da capacidade funcional em pacientes com patients with inflammatory polyarthritis. Clin Calcium. 2013;23(5):701–5. artrite reumatoide: implicações para a recomendação de exercícios físicos. Rev Bras Reumatol [Internet]. 2014;4(5):378–85. Available from: http://www. 19. Lourenço MA, Roma I, Assis MR. Ocorrência de quedas e sua associação sciencedirect.com/science/article/pii/S0482500414001144 com testes físicos, capacidade funcional e aspectos clínicos e demográficos 42. Cummings SR, Nevitt MC, Kidd S. Forgetting falls. The limited accuracy of em pacientes com artrite reumatoide. Rev Bras Reum. 2017;57(3):217–23. recall of falls in the elderly. J Am Geriatr Soc. 1988;36(7):613–6. 20. Lourenço MA, Roma I, Assis MR. Correlação entre instrumentos de avaliação da funcionalidade e equilíbrio em pacientes com artrite reumatoide. Rev Bras Educ Fís Esporte. 2015;29(3):345–53. 21. Da Mota LMH, Cruz BA, Brenol CV, Pereira IA, Fronza LSR, Bertolo MB, et al. Consenso da Sociedade Brasileira de Reumatologia 2011 para o diagnóstico e avaliação inicial da artrite reumatoide. Rev Bras Reumatol. 2011;51(3):207–19. 22. Bruce B, Fries JF. The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol. 2005;23(5 SUPPL. 39):S14–8. 23. Ferraz MB, Oliveira LM, Araujo PMP, Atra E, Tugwell P. Crosscultural reliability of the physical ability dimension of the health assessment questionnaire. J Rheumatol. 1990 Jun;17(6):813–7. 24. Figueiredo KMOB, Lima KC, Guerra RO. Instrumentos de avaliação do equilíbrio corporal em idosos. Rev Bras Cineantropom Desempenho Hum. 2007;9(4):408–13. 25. Pimentel RM, Scheicher ME. Comparação do risco de queda em idosos sedentários e ativos por meio da escala de equilíbrio de Berg. Fisioter Pesq. 2009;16(1):6–10. 26. Miyamoto ST, Lombardi Junior I, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg balance scale. Braz J Med Biol Res. 2004 Sep;37(9):1411– 21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15334208. 27. Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil. 1992;73(11):1073–80. 28. Nakano MM, Diogo MJDe, Jacob Filho W. Versão brasileira da Short Physical Performance Battery - SPPB: adaptação cultural e estudo da confiabilidade. UNICAMP; 2007. 29. Sayers SP, Jette AM, Haley SM, Heeren TC, Guralnick JM, Fielding RA. Validation of thelate-life function and disability instrument. J Am Geriatr Soc. 2004;52(9):1554–9. 30. Guimarães LHCT, Galdino DCA, Martins FLM, Vitorino DFM, Pereira KL, Carvalho EM. Comparação da propensão de quedas entre idosos que praticam atividade física e idosos sedentários. Rev Neurociências. 2004;12(2): 68–72. 31. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther. 2000;80(9):896–903. 32. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc [Internet]. 1991 Feb;39(2): 142–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1991946. 33. Cipriano Junior G, Yuri D, Bernardelli GF, Mair V, Buffolo E, Branco JNR. Avaliação da Segurança do Teste de Caminhada dos 6 Minutos em Pacientes no Pré-Transplante Cardíaco. Arq Bras Cardiol. 2009;92(4):312–9. 34. Rondelli R, Oliveira A, Corso SD, Malaguti C. Uma atualização e proposta de padronização do teste de caminhada de seis minutos. Fisioter Mov. 2009; 22(2):249–59. 35. Oswald AE, Pye SR, O’Neill TW, Bunn D, Gaffney K, Marshall T, et al. Prevalence and associated factors for falls in women with established inflammatory polyarthritis. J Rheumatol. 2006 Apr;33(4):690–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16482644. 36. Stanmore EK, Oldham J, Skelton D a, O’Neill T, Pilling M, Campbell a J, et al. Risk factors for falls in adults with rheumatoid arthritis: A prospective study. Arthritis Care Res (Hoboken). 2013 Feb; 37. Metlı NB, Kurtaran A, Akyüz M. Impaired balance and fall risk in rheumatoid arthritis patients. Turk J Phys Med Rehab. 2015;61:344–51. 38. Robbins AS, Rubenstein LZ, Josephson KR, Schulman BL, Osterweil D, Fine G. Predictors of falls among elderly people. Results of two population-based studies. Arch Intern Med. 1989;149:1628–33. 39. Furuya T, Yamagiwa K, Ikai T, Inoue E, Taniguchi A, Momohara S, et al. Associated factors for falls and fear of falling in Japanese patients with http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Advances in Rheumatology Springer Journals

Characterization of falls in adults with established rheumatoid arthritis and associated factors

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Springer Journals
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Copyright © 2018 by The Author(s)
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Medicine & Public Health; Rheumatology
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2523-3106
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DOI
10.1186/s42358-018-0021-0
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Abstract

Background: Rheumatoid arthritis patients may have an increased risk of falls due to changes caused by the disease such as muscle weakness, joint impairment, reduced mobility and postural instability. The aim of this study was to prospectively analyze the occurrence of falls in RA patients and its risk factors. Methods: A cohort of 86 RA patients were assessed over 1 year for disease activity using the Disease Activity Score (DAS-28), for functionality using the Health Assessment Questionnaire (HAQ), for the characterization of falls and for the use of medications, and they were subjected to the Berg Balance Scale (Berg), Timed Up and Go (TUG), 6- Minute Walk (6MWT) and Short Physical Performance Battery (SPPB) tests. The Kolmogorov-Smirnov, Spearman’s correlation, Student’s t, Mann-Whitney and chi-square tests were performed with a significance level of P ≤ 0.05. Results: A total of 86 patients were evaluated, of which 48.8% had at least one fall and 75.6% reported having a fear of falling. No association of falls with age, disease duration, functional capacity, disease activity or physical performance was found. Patients with poorer performance in the physical tests had more functional impairment, higher disease activity and more advanced age. No differences in physical or functional performance, disease activity, gender or fear of falling were found between fallers and non-fallers; only a greater amount of medications used was found in the group of fallers. Conclusions: The occurrence of falls was high and associated with a previous history of falls and polypharmacy, with no association with disease activity or duration, functional capacity, physical performance, age or gender. Keywords: Postural balance, Physical aptitude, Rheumatoid arthritis, Accidental falls Background prospective studies have shown associations with altered Falls have a multifactorial etiology in the elderly, mainly balance, use of psychotropic medications, fear of falling due to intrinsic factors such as decreased muscle and previous falls [4–8]. However, findings regarding strength, balance deficits, and gait pattern changes. several other risk factors, the characterization of falls These age-related changes can also be observed in other and the consequences of falls in RA patients are still diseases [1–3]. scarce or contradictory. Rheumatoid arthritis (RA) is a chronic systemic in- The aim of this study was to prospectively analyze the flammatory autoimmune disease of joint predominance, occurrence of falls in RA patients for 1 year and to in- with a high prevalence of falls occurring in 14.3 to 54% vestigate whether physical fitness and balance tests, of patients over a one-year period, which are high values medication use, previous history of falls, disease activity compared to the general population [4–19]. This in- and functionality are associated with falls. creased risk of falls may be due to pain, edema, deform- ities, loss of muscle strength or gait changes, and Methods Sample * Correspondence: maalmeida1@terra.com.br A prospective study based on the sample of a previous Marília School of Medicine, R. Pedro Martins, 209. Marília/SP – Brazil, Marília, São Paulo CEP 17519-430, Brazil retrospective study composed of 99 patients diagnosed © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Lourenço et al. Advances in Rheumatology (2018) 58:16 Page 2 of 6 with RA was conducted at the Rheumatology outpatient performed five times with the arms crossed in front of clinic of the Marília School of Medicine [19, 20]. the chest, and time is also recorded in seconds [28, 29]. Adults with a diagnosis of RA according to the The Timed Up and Go Test (TUG) was used to assess American College of Rheumatology (ACR) classifica- body balance and risk of falls, especially in the elderly. tion criteria of 1987 and/or the 2010 ACR/EULAR The test begins with the patient sitting on a chair, then (European League Against Rheumatism) RA classifica- getting up, walking a three-meter distance, making a tion criteria were included [21]. Patients with cogni- 180° turn, returning and sitting on the same chair. The tive impairments precluding them from answering the different lengths of time spent indicate the following: questionnaires, using a wheelchair or with other phys- ≤10 s - elderly without balance alteration and with low ical disabilities that impeded the execution of the risk of falls; between 10 and 20 s - elderly with no sig- tests were excluded. nificant balance alteration but presenting some weakness The study was approved by the Research Ethics Com- and medium risk of falls; and ≥ 20 s - elderly with a high mittee of the Marília School of Medicine, protocol risk of falls [30]. Other studies consider a higher risk of CAAE: 22845513.3.0000.5413. All participants signed falls between 10 and 14 s [24, 31, 32]. the informed consent form. The 6-Minute Walk Test (6MWT) was used to assess functional capacity and exercise tolerance through the distance an individual is able to walk on a hard, flat sur- Procedure face for 6 min. In healthy adults, the reference values are The rheumatologist confirmed the RA diagnosis and 580 m for men and 500 m for women [33, 34]. performed the measurements to assess disease activity, and the nurse collected the blood samples. Next, the an- thropometric data were measured, and the functional Statistical analysis questionnaires and physical tests were applied by the The Kolmogorov-Smirnov (KS) test was used to evaluate nurse and the physical therapist. the normality of the data distribution. Values were From the initial evaluation, the patients were followed expressed as the mean and standard deviation (SD) for up for 1 year by quarterly telephone contact to record variables with normal distribution and as the median the occurrence of falls and their characteristics. After and percentages for the others. Correlations were ana- 12 months, the disease activity and functionality assess- lyzed using Spearman’s test, and other analyses were ments and physical tests were repeated. conducted using Student’s t-test, the Mann-Whitney U-test and chi-square tests with a significance level of p < 0.05. The statistical program used was SPSS v.21 Instruments (IBM Armonk, NY, USA, 2012). Patients were assessed for disease activity using the Dis- ease Activity Score (DAS-28) [21], for functional cap- acity using the Health Assessment Questionnaire (HAQ) Results [22, 23] and for the occurrence of falls using a fall A total of 99 patients were included in the study, but 13 characterization questionnaire [19, 20]. were lost – three died, three had medical follow-up unit The following physical tests were performed: changes, three were not found, two were bedridden, one The Berg Balance Scale was used to determine risk refused to participate, and one suffered an ankle sprain factors for loss of independence and falls in the elderly. – leaving 86 patients. The majority of the sample con- The scale has 14 items common to daily life, scored sisted of white married women with a mean age of 55 ± from 0 to 4, with a higher fall risk associated with lower 11.8 years (Table 1). scores. The predictive value of falls in the elderly ranges There were 67 fall episodes in the one-year follow-up from 45 to 48 [24–27]. period; 48.8% of these patients fell at least once, and The Short Physical Performance Battery (SPPB) was 75.6% reported the fear of experiencing a fall episode. used to assess standing balance, walking ability and Falls occurred most often at home (58.2%), in the morn- sit-to-stand performance. The three items are scored ing (41.8%), while the patients walked (65.7%) and due from 0 to 4, with poorer physical function associated to tripping and slipping (65.5%), and fracture occurred with lower scores. Standing balance is evaluated in three in three falls (4.4% of the total). positions with progressive difficulty - feet together, with No association was found between the number of falls the hallux leaning against the medial edge of the oppos- and age, disease duration, functional capacity, disease ac- ite heel and with the hallux leaning against the posterior tivity or physical performance. Patients with poorer per- edge of the opposite heel. Walking is evaluated by meas- formance on the physical tests had more functional uring time, in seconds, for a distance of four meters. In impairment, higher disease activity and advanced age. the sit-to-stand evaluation using a chair, the action is The higher disease activity was associated with poorer Lourenço et al. Advances in Rheumatology (2018) 58:16 Page 3 of 6 Table 1 Characteristics of the sample of patients with rheumatoid arthritis Participants, n 86 Women, n (%) 76 (88.4) Age (years), mean ± SD (min-max) 55 ± 11.8 (23–88) BMI (kg/m ), mean ± SD (min-max) 27.7 ± 5.3 (15.35–40.04) Self-reported ethnicity, n (%) White 54 (62.8) Mixed 20 (23.3) Black 12 (14) Marital status, n (%) Married 52 (62.8) Single 14 (16.3) Divorced 10 (11.6) Widowed 8 (9.3) Duration of disease (years), median (P25–75) (min-max) 10 (5–16.5); (2–40) Self-reported associated diseases (%) HBP 53.5 Osteoporosis 17.4 DM 12.6 Labyrinthitis 11.6 HF 8.1 Fibromyalgia 7.0 Hypothyroidism 7.0 Depression 3.4 Falls in the previous year (%) 37.4 Walking aids (%) 9.3 n: number; %: percentage; SD: standard deviation; min: minimum; max: maximum; BMI: body mass index; kg: kilogram; m : square meter; P25–75: 25th percentile and 75th percentile; HBP: high blood pressure; DM: diabetes mellitus; HF: heart failure physical performance, poorer functional capacity and regarding physical or functional performance, disease ac- longer disease duration (Table 2). tivity, gender or fear of falling (Tables 4 and 5). The There was no significant difference in functional cap- number of medications used and history of falls differed acity or disease activity in the initial evaluation and after significantly between fallers and non-fallers (Table 5). 1 year. However, in the physical tests, better perform- ance was observed in the final evaluation when com- Discussion pared to the initial evaluation (Table 3). The incidence of falls in this sample of RA patients When divided into groups according to the occurrence was high (48.8%) compared to that found in the lit- of falls, considering fallers as patients with at least one erature, which shows ranges from 14.3 to 54% in fall episode during the follow-up period, no significant retrospective studies and from 18.8 to 50% in pro- differences were found between fallers and non-fallers spective studies [4–9, 11–19]. The incidence of falls Table 2 Correlations between the number of falls with clinical variables and functional tests Number of falls, r (P) Age, r (P) HAQ, r (P) DAS28, r (P) Age 0.059 (0.592) – − 0.109 (0.317) 0.034 (0.755) RA duration − 0.077 (0.483) 0.187 (0.087) 0.066 (0.550) 0.224 (0.039)* HAQ 0.151 (0.165) −0.109 (0.317) – 0.468 (0.000)* DAS28 0.004 (0.973) 0.034 (0.755) 0.468 (0.000)* – Berg −0.127 (0.244) −0.367 (0.001)* − 0.541 (0.000)* −0.422 (0.000)* 6MWT −0.124 (0.260) −0.244 (0.024)* − 0.495 (0.000)* −0.294 (0.006)* TUG 0.064 (0.558) 0.243 (0.025)* 0.557 (0.000)* 0.363 (0.001)* SPPB −0.121 (0.266) −0.291 (0.007)* − 0.658 (0.000)* −0.404 (0.000)* RA: rheumatoid arthritis; HAQ: Health Assessment Questionnaire; DAS28: Disease Activity Score 28; Berg: Berg Balance Scale; 6MWT: 6-min walk test; TUG: Timed Up and Go; SPPB: Short Physical Performance Battery; r: Spearman’s correlation; P: significance level Lourenço et al. Advances in Rheumatology (2018) 58:16 Page 4 of 6 Table 3 Initial and final scores on physical, functional and disease activity tests Initial Final P HAQ, median (P25–75) 0.62 (0.12–1.25) 0.62 (0.12–1.37) 0.318 DAS28, mean (±SD) 3.40 (±1.17) 3.58 (±1.32) 0.215 6MWT (meters), mean (±SD) 391.27 (±103.78) 429.52 (±129.01) 0.001 Berg, median (P25–75) 53 (49.75–56) 55 (50.75–56) 0.019 TUG (seconds), median (P25–75) 8.89 (7.59–11.69) 8.75 (7.14–11.28) 0.071 SPPB, median (P25–75) 10 (8–12) 11 (9–12) 0.001 HAQ: Health Assessment Questionnaire; DAS28: Disease Activity Score 28; 6MWT: 6-min walk test; Berg: Berg Balance Scale; TUG: Timed Up and Go; SPPB: Short Physical Performance Battery; P25–75: 25th percentile and 75th percentile; SD: standard deviation; P: t test significance level observed was also high compared to that of non- The history of falls was associated with the occurrence institutionalized elderly individuals, which ranges from of new falls, which indicates the need for special atten- 15.9 to 56.3% [2]. Although age is an important risk factor tion in the evaluation of RA patients who have already for falls, the association between falls and advanced age fallen [4, 6, 7, 36]. was not observed in this sample, which is in agreement Most of the sample presented moderate disease activ- with previous RA studies [4–6, 12, 15, 35]. ity, which, similar to the study by Bohler et al. [12], was Comparing fallers with non-fallers, there was again associated with poorer performance in most physical agreement with other RA studies but a difference from tests, but not the occurrence of falls. Koerich et al. [40] what occurs in the elderly - there was no predominance argued that the level of disease activity may influence of falls among females. It is possible that no difference physical performance (Berg and TUG), suggesting an in- was observed between men and women because both creased risk of falling or dependence in performing ac- genders have decreased muscle mass and similar pat- tivities of daily life. The lack of association between poor terns of medication consumption [5–7, 15, 35]. physical performance and disease activity with the pres- The use of several medications may increase the oc- ence of falls may be related to the time of evaluation, currence of falls due to interactions between medica- which usually occurs at the beginning or end of the tions or their side effects. In the present study, we study and not at the time of the falls. Another reason- found a significant difference between fallers and able explanation is that the increased disease activity re- non-fallers in relation to polypharmacy. Armstrong et sults in restriction of activities and therefore reduces the al. [15] reported an association between a higher num- individuals’ exposure to situations with a risk of falls. ber of medications and a higher risk of falling, while Other studies have indicated functional disability as a Stanmore et al. [36] found that using four or more risk factor for falls, but in our study, although it was as- medications more than doubles the risk of falling in RA sociated with poorer performance in physical tests, it patients. An association has also been found between was not correlated with falls [4, 9, 12, 13, 19, 20, 35]. In falls and the use of medications such as antihyperten- a prospective study with 80 patients in Japan, Hayashi- sives, diuretics, sedatives, antidepressants and antipsy- bara et al. [6] found no relationship between functional chotics [6, 8, 15, 36–39]. disability and the presence of falls and explained that the Table 5 Differences between number of medications, history of Table 4 Differences between disease activity and physical and falls, gender and fear of falling between fallers and non-fallers functional performance in fallers and non-fallers Occurrence Fallers (n = 42) Non-fallers (n = 44) Test P of falls (n) HAQ 0.81 (0.22–1.75) 0.50 (0.12–1.34) U = 763.5 0.164 No Yes χ P DAS28 3.70 (±1.49) 3.47 (±1.16) t = −0.798 0.427 Polypharmacy Up to three medications 20 9 5.55 0.018 6MWT 376.31 (±100.74) 405.88 (±105.79) t = 1.320 0.190 Four or more 24 33 Berg 53 (47.75–55.25) 54.5 (50–56) U = 787 0.229 History of falls Yes 10 22 8.087 0.004 TUG 9.27 (7.89–11.62) 8.73 (7.35–12.08) U = 852 0.660 No 34 20 SPPB 10 (7.75–11) 10.5 (9–12) U = 784.5 0.219 Gender Female 38 38 0.354 0.552 HAQ: Health Assessment Questionnaire; DAS28: Disease Activity Score 28; Male 6 4 6MWT: 6-min walk test; Berg: Berg Balance Scale; TUG: Timed Up and Go; Fear of falling Present 31 31 0.120 0.729 SPPB: Short Physical Performance Battery; P: significance level; t: t test; U: Mann-Whitney U-test Absent 13 11 Values are expressed as the mean (± standard deviation) or median (25th - 75th percentile) X : chi-square; P: significance level Lourenço et al. Advances in Rheumatology (2018) 58:16 Page 5 of 6 findings were due to the fact that five of the eight HAQ Ethics approval and consent to participate The study was approved by the Research Ethics Committee of the Marília categories assess the function of the upper limbs. School of Medicine, protocol CAAE: 22845513.3.0000.5413. All participants Although the physical tests used in the present study signed the informed consent form. are aimed at the elderly population, RA patients may Consent for publication present an early decrease in muscle strength, physical Not applicable. activity and balance in a pattern similar to that of elderly individuals, anticipating the risks resulting from the Competing interests The authors declare that they have no competing interests aging process. This may explain the finding that per- formance on physical tests was correlated with age: the Publisher’sNote older the patient, the poorer the physical performance. Springer Nature remains neutral with regard to jurisdictional claims in Although the four physical tests were significantly corre- published maps and institutional affiliations. lated among themselves, no significant association was Received: 14 May 2018 Accepted: 13 July 2018 found between any of the tests and the occurrence of falls. While some studies found an association between poorer performance on physical tests and a greater oc- References 1. Pinho TAM, Silva AO, Tura LFR, Moreira MASP, Gurgel SN, Smith AAF, et al. currence of falls or risk of falling, others found no such Avaliação do risco de quedas em idosos atendidos em Unidade Básica de association [6, 11, 12, 16, 19, 36, 37]. The lack of Saúde. Rev Esc Enferm USP. 2012;46(2):320–7. standardization in the choice of tests for the RA popula- 2. Sandoval RA, Sá ACAM, Menezes RL, Nakatani AYK, Bachion MM. Ocorrência de quedas em idosos não institucionalizados : revisão sistemática da tion may be an important factor to be considered when literatura. Rev Bras Geriatr Gerontol. 2013;16(4):855–63. analyzing these results, a gap that was observed by San- 3. Oliveira AS, Trevizan PF, Bestetti MLT, Melo RC. Fatores ambientais e risco de tana et al. [41]. quedas em idosos: revisão sistemática. Rev Bras Geriatr Gerontol. 2014;17(3): 637–45. Several studies suggest that prospective studies be 4. Smulders E, Schreven C, Weerdesteyn V, van den Hoogen FHJ, Laan R, Van conducted to minimize memory bias [13–15, 19]. Cum- Lankveld W. Fall incidence and fall risk factors in people with rheumatoid mings et al. [42], in a prospective, 12-month study of the arthritis. Ann Rheum Dis. 2009 [cited 2013 may 23];68(11):1795–1796. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19822719. elderly, found that 13–32% of the participants who fell 5. Stanmore EK, Oldham J, Skelton DA, O’Neill T, Pilling M, Campbell AJ, et al. did not report the episode at the end of the evaluation Fall incidence and outcomes of falls in a prospective study of adults with period. The follow-up strategies used were calendars, rheumatoid arthritis. Arthritis Care Res (Hoboken). 2013;65(5):737–44. 6. Hayashibara M, Hagino H, Katagiri H, Okano T, Okada J, Teshima R. journals, fall log cards and self-reports to the researcher Incidence and risk factors of falling in ambulatory patients with rheumatoid at the time of the fall. The present study has a methodo- arthritis: a prospective 1-year study. Osteoporos Int. 2010 [cited 2013 may logical advantage, as it obtained the information quar- 23];21(11):1825–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/ terly by telephone, which improved the reliability of the 7. Bugdayci D, Paker N, Rezvani A, Kesiktas N, Yilmaz O, Sahin M, et al. report of falls and facilitated detailed clarification regard- Frequency and predictors for falls in the ambulatory patients with ing the characteristics [4–8, 36]. rheumatoid arthritis: a longitudinal prospective study. Rheumatol Int. 2013 Apr;33(10):2523–7. 8. Brenton-Rule A, Dalbeth N, Bassett S, Menz HB, Rome K. The incidence and risk factors for falls in adults with rheumatoid arthritis: a systematic review. Conclusions Semin Arthritis Rheum. 2015;44:389–98. 9. Kaz Kaz H, Johnson D, Kerry S, Chinappen U, Tweed K, Patel S. Fall-related The occurrence of falls in RA patients is high and is as- risk factors and osteoporosis in women with rheumatoid arthritis. sociated with a previous history of falls and polyphar- Rheumatology (Oxford). 2004;43(10):1267–71. Available from: https:// macy, showing no association with disease activity or academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/ keh304 duration, functional capacity, physical performance, age 10. Pereira IA, Mota LMH, Cruz BA, Brenol CV, Fronza LSR, Bertolo MB, et al. or gender. In addition, the performances in the physical Consenso 2012 da Sociedade Brasileira de Reumatologia sobre o manejo de tests were associated with each other, and a poorer phys- comorbidades em pacientes com artrite reumatoide. Rev Bras Reum. 2012; 52(4):474–95. ical condition was related to greater disease activity, 11. Duyurçakit B, Nacir B, Erdem HR, Karagoz A, Saraçoglu M. Fear of falling, fall poorer functional capacity and older age. risk and disability in patients with rheumatoid arthritis. Turk J Rheumatol. 2011;26(3):217–25. 12. Böhler C, Radner H, Ernst M, Binder A, Stamm T, Aletaha D, et al. Funding Rheumatoid arthritis and falls: the influence of disease activity. A Master’s degree fellowship from Coordenação de Aperfeiçoamento de Rheumatology (Oxford). 2012 [cited 2013 may 23];51(11):2051–2057. Pessoal de Nível Superior (CAPES). Available from: http://www.ncbi.nlm.nih.gov/pubmed/22879462. 13. Marques WV, Cruz VA, Rêgo J, Silva NA. Influência da capacidade funcional no risco de quedas em adultos com artrite reumatoide. Rev Bras Reum. Authors’ contributions 2014;54(5):404–8. The rheumatologist (MRA) confirmed the RA diagnosis and performed the 14. Fessel KD, Nevitt MC. Correlates of fear of falling and activity limitation measurements to assess disease activity, and the nurse (FVBOC) collected the among persons with rheumatoid arthritis. Arthritis Care Res. 1997;10(4): blood samples. Next, the anthropometric data were measured, and the 222–8. functional questionnaires and physical tests were applied by the nurse and the 15. Armstrong C, Swarbrick CM, Pye SR, O’Neill TW. Occurrence and risk factors physical therapist (MAL). All authors read and approved the final manuscript. for falls in rheumatoid arthritis. Ann Rheum Dis. 2005;64(11):1602–4. Lourenço et al. Advances in Rheumatology (2018) 58:16 Page 6 of 6 16. Jamison M, Neuberger GB, Miller PA. Correlates of falls and fear of falling rheumatoid arthritis. Clin Rheumatol. 2009 Nov [cited 2013 may 23];28(11): among adults with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2003; 1325–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19618097. 49(5):673–80. 40. Koerich J, Armanini KK, Iop RR, Borges Júnior NG, Domenech SC, Gevaerd 17. Schober HC, Maass K, Maass C, Reisinger EC, Schröder G, Kneitz C. Value of MS. Avaliação do equilíbrio corporal de pacientes com artrite reumatoide. fall-risk tests for patients with rheumatoid arthritis. Z Rheumatol. 2011;70(7): Fisioter e Pesq. 2013;20(4):336–42. 609–14. 41. De Santana FS, Nascimento DDC, De Freitas JPM, Miranda RF, Muniz LF, 18. Sugioka Y, Koike T. Fall risk and fracture. Associated factors for falls in Santos Neto L, et al. Avaliação da capacidade funcional em pacientes com patients with inflammatory polyarthritis. Clin Calcium. 2013;23(5):701–5. artrite reumatoide: implicações para a recomendação de exercícios físicos. Rev Bras Reumatol [Internet]. 2014;4(5):378–85. Available from: http://www. 19. Lourenço MA, Roma I, Assis MR. Ocorrência de quedas e sua associação sciencedirect.com/science/article/pii/S0482500414001144 com testes físicos, capacidade funcional e aspectos clínicos e demográficos 42. Cummings SR, Nevitt MC, Kidd S. Forgetting falls. The limited accuracy of em pacientes com artrite reumatoide. Rev Bras Reum. 2017;57(3):217–23. recall of falls in the elderly. J Am Geriatr Soc. 1988;36(7):613–6. 20. Lourenço MA, Roma I, Assis MR. Correlação entre instrumentos de avaliação da funcionalidade e equilíbrio em pacientes com artrite reumatoide. Rev Bras Educ Fís Esporte. 2015;29(3):345–53. 21. Da Mota LMH, Cruz BA, Brenol CV, Pereira IA, Fronza LSR, Bertolo MB, et al. Consenso da Sociedade Brasileira de Reumatologia 2011 para o diagnóstico e avaliação inicial da artrite reumatoide. Rev Bras Reumatol. 2011;51(3):207–19. 22. Bruce B, Fries JF. The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol. 2005;23(5 SUPPL. 39):S14–8. 23. Ferraz MB, Oliveira LM, Araujo PMP, Atra E, Tugwell P. Crosscultural reliability of the physical ability dimension of the health assessment questionnaire. J Rheumatol. 1990 Jun;17(6):813–7. 24. Figueiredo KMOB, Lima KC, Guerra RO. Instrumentos de avaliação do equilíbrio corporal em idosos. Rev Bras Cineantropom Desempenho Hum. 2007;9(4):408–13. 25. Pimentel RM, Scheicher ME. Comparação do risco de queda em idosos sedentários e ativos por meio da escala de equilíbrio de Berg. Fisioter Pesq. 2009;16(1):6–10. 26. Miyamoto ST, Lombardi Junior I, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg balance scale. Braz J Med Biol Res. 2004 Sep;37(9):1411– 21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15334208. 27. Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil. 1992;73(11):1073–80. 28. Nakano MM, Diogo MJDe, Jacob Filho W. Versão brasileira da Short Physical Performance Battery - SPPB: adaptação cultural e estudo da confiabilidade. UNICAMP; 2007. 29. Sayers SP, Jette AM, Haley SM, Heeren TC, Guralnick JM, Fielding RA. Validation of thelate-life function and disability instrument. J Am Geriatr Soc. 2004;52(9):1554–9. 30. Guimarães LHCT, Galdino DCA, Martins FLM, Vitorino DFM, Pereira KL, Carvalho EM. Comparação da propensão de quedas entre idosos que praticam atividade física e idosos sedentários. Rev Neurociências. 2004;12(2): 68–72. 31. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther. 2000;80(9):896–903. 32. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc [Internet]. 1991 Feb;39(2): 142–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1991946. 33. Cipriano Junior G, Yuri D, Bernardelli GF, Mair V, Buffolo E, Branco JNR. Avaliação da Segurança do Teste de Caminhada dos 6 Minutos em Pacientes no Pré-Transplante Cardíaco. Arq Bras Cardiol. 2009;92(4):312–9. 34. Rondelli R, Oliveira A, Corso SD, Malaguti C. Uma atualização e proposta de padronização do teste de caminhada de seis minutos. Fisioter Mov. 2009; 22(2):249–59. 35. Oswald AE, Pye SR, O’Neill TW, Bunn D, Gaffney K, Marshall T, et al. Prevalence and associated factors for falls in women with established inflammatory polyarthritis. J Rheumatol. 2006 Apr;33(4):690–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16482644. 36. Stanmore EK, Oldham J, Skelton D a, O’Neill T, Pilling M, Campbell a J, et al. Risk factors for falls in adults with rheumatoid arthritis: A prospective study. Arthritis Care Res (Hoboken). 2013 Feb; 37. Metlı NB, Kurtaran A, Akyüz M. Impaired balance and fall risk in rheumatoid arthritis patients. Turk J Phys Med Rehab. 2015;61:344–51. 38. Robbins AS, Rubenstein LZ, Josephson KR, Schulman BL, Osterweil D, Fine G. Predictors of falls among elderly people. Results of two population-based studies. Arch Intern Med. 1989;149:1628–33. 39. Furuya T, Yamagiwa K, Ikai T, Inoue E, Taniguchi A, Momohara S, et al. Associated factors for falls and fear of falling in Japanese patients with

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