Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Associated Factors for Falls and Fear of Falls in Japanese Patients with Rheumatoid Arthritis

Furuya,  Takefumi, Yamagiwa,  Kiyotaka, Ikai,  Tetsuo, Inoue,  Eisuke, Taniguchi,  Atsuo, Momohara,  Shigeki, Yamanaka,  Hisashi

Purpose:

Patients with rheumatoid arthritis (RA) have an increased risk of fractures and falls compared to healthy controls. Utilizing data from our observational study of RA in Japan (IORRA, Institute of Rheumatology Rheumatoid Arthritis), we have previously reported that the incidence of fractures in Japanese women (J Rheumatol 2007;34:303-10) and men (J Bone Miner Metab 2008;26:499–505) with RA was mainly caused by falls. Limited data exist in the literature concerning the risk factors for falls in RA patients. We attempted to determine factors associated with falls in Japanese patients with RA.

Method:

Among the Japanese patients who participated our IORRA observational study, 4996 (male 765, female 4231, median age 60 yrs) responded to questions related to falls during the previous 6 months in April or May 2008. Logistic regression was used to determine the association between variables and falls.

Results:

Five hundred and five (10.1%), 110 (2.2%), and 958 patients (19.2%) reported at least one fall, multiple falls, and fear of falling, respectively. Those who fell tended to report incident fractures during the same 6 months compared to those who did not (14.7% versus 1.1%, P < 0.001). In multivariate models, Japanese health assessment questionnaire (J-HAQ) scores (odds ratios [OR] 1.52, 2.49, and 3.88), tender joint counts (OR 1.39, 1.72, and 1.36), patient-reported visual analog scale (VAS) for general health (OR 1.08, 1.16, and 1.20) and body mass index (BMI) (OR 1.05, 1.08, and 1.04) were associated (P < 0.05) with at least one fall, multiple falls, and fear of falling, respectively (Table). Other clinical variables and medications were also associated with falls and fear of falling (Table).

Table. Adjusted odds ratios (OR) and associated 95% confidence intervals (CI) for at least one or two falls, and the fear of falling in Japanese patients with rheumatoid arthritis: logistic-regression models with step-wise selection

VariablesAt least one fallAt least two fallsFear of falling
Age, years1.01 (1.00, 1.01)not selected1.03 (1.02, 1.04)
BMI, kg/m21.05 (1.02, 1.08)1.08 (1.02, 1.15)1.04 (1.01, 1.07)
J-HAQ score, 0–31.52 (1.31, 1.77)2.49 (1.82, 3.42)3.88 (3.33, 4.55)
VAS-general health, 0–10cm1.08 (1.03, 1.13)1.16 (1.00, 1.34)1.20 (1.14, 1.26)
Tender joint counts1.39 (1.14, 1.70)1.72 (1.26, 2.32)1.36 (1.05, 1.76)
Swollen joint counts0.64 (0.43, 0.92)0.48 (0.19, 1.05)0.85 (0.60, 1.21)
Prednisolone dose, mg/day1.02 (0.99, 1.05)not selected1.04 (1.01, 1.08)
Methotrexate use0.85 (0.69, 1.05)0.53 (0.35, 0.80)not selected
Active vitamin D3 use1.43 (1.10, 1.84)1.69 (1.02, 2.72)not selected

Conclusion:

HAQ disability score, tender joint counts, and impaired general health appear to be associated with falls in Japanese patients with RA as previously reported in other ethnicities. BMI appears to be related to falls and fear of falling in Japanese patients with RA. Since our cross-sectional study design may not have been adequate to evaluate the efficacy of medications, further randomized controlled or prospective observational studies are needed to conclude the associations.

To cite this abstract, please use the following information:
Furuya, Takefumi, Yamagiwa, Kiyotaka, Ikai, Tetsuo, Inoue, Eisuke, Taniguchi, Atsuo, Momohara, Shigeki, et al; Associated Factors for Falls and Fear of Falls in Japanese Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheum 2009;60 Suppl 10 :862
DOI: 10.1002/art.25942

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