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Prevalence and risk factors of falls in adults with rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2023; 60:152186. [PMID: 36933303 DOI: 10.1016/j.semarthrit.2023.152186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Despite the fact that the estimated prevalence and risk factors of falls in adults with rheumatoid arthritis (RA) are widely reported, these results have not been synthesized. The systematic review and meta-analysis aimed to investigate the prevalence and risk factors of falls in adults with RA. METHODS PubMed, EMBASE, Web of Science, the Cochrane Library, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched for relevant studies published from the inception of the database until July 4, 2022. Stata 15.0 Software was used to perform the meta-analysis. For the prevalence of falls in adults with RA and risk factors that were investigated in at least 2 studies in a comparable way, we calculated pooled incidence and odds ratios (ORs) using random-effects models, with a test for heterogeneity. A study protocol was registered in PROSPERO (CRD42022358120). RESULTS A total of 6,470 articles were screened and data from 34 studies involving 24,123 subjects were used in meta-analysis. The pooled prevalence of any falls was 34% (95% confidence interval, CI: 29% to 38%, I2=97.7%, P<0.001), and 16% for recurrent falls (95% CI: 12% to 20%, I2=97.5%, P<0.001). 25 risk factors were considered, including sociodemographic, medical and psychological, medication, and physical function. The strongest associations were found for history of falls (OR=3.08, 95%CI: 2.32 to 4.08, I2=0.0%, P = 0.660), history of fracture (OR=4.03, 95%CI: 3.12 to 5.21, I2=97.3%, P<0.001), walking aid use (OR=1.60, 95%CI: 1.23 to 2.08, I2=67.7%, P = 0.026), dizziness (OR=1.95, 95%CI: 1.43 to 2.64, I2=82.9%, P = 0.003), psychotropic medication use (OR=1.79, 95%CI: 1.39 to 2.30, I2=22.0%, P = 0.254), antihypertensive medicine/diuretic (OR=1.83, 95%CI: 1.37 to 2.46, I2=51.4%, P = 0.055), taking four or more medicine(OR=1.51, 95%CI: 1.26 to 1.81, I2=26.0%, P = 0.256), and HAQ score(OR=1.54, 95%CI: 1.40 to 1.69, I2=36.9%, P = 0.135). CONCLUSIONS This meta-analysis provides a comprehensive evidence-based assessment of the prevalence and risk factors for falls in adults with RA, confirming their multifactorial etiology. Understanding the risk factors of falls can provide healthcare personnel with a theoretical basis for the management and prevention of RA patients.
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Wiegmann S, Armbrecht G, Borucki D, Buehring B, Buttgereit F, Detzer C, Schaumburg D, Zeiner KN, Dietzel R. Balance and prospective falls in patients with rheumatoid arthritis. BMC Musculoskelet Disord 2022; 23:549. [PMID: 35672724 PMCID: PMC9175329 DOI: 10.1186/s12891-022-05489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
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®. 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. Trial registration The study has been registered at the German Clinical Trials Register and the WHO International Clinical Trials Registry Platform (ICTRP) since 16 March 2017 (DRKS00011873).
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Affiliation(s)
- Sabine Wiegmann
- Department of Radiology, Centre for Muscle and Bone Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Gabriele Armbrecht
- Department of Radiology, Centre for Muscle and Bone Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Diana Borucki
- Deutsche Rheuma-Liga Bundesverband e.V., Welschnonnenstraße 7, 53111, Bonn, Germany
| | - Bjoern Buehring
- Bergisches Rheuma-Zentrum, Krankenhaus St. Josef, Bergstr. 6-12, 42105, Wuppertal, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian Detzer
- Deutsche Rheuma-Liga Bundesverband e.V., Welschnonnenstraße 7, 53111, Bonn, Germany
| | - Désirée Schaumburg
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kim Nikola Zeiner
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Department of Dermatology, Venereology and Allergology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Roswitha Dietzel
- Department of Radiology, Centre for Muscle and Bone Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
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Gwinnutt JM, Wieczorek M, Cavalli G, Balanescu A, Bischoff-Ferrari HA, Boonen A, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda MI, Guillemin F, Verstappen SMM. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:rmdopen-2021-002168. [PMID: 35361692 PMCID: PMC8971792 DOI: 10.1136/rmdopen-2021-002168] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs. METHODS Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013-2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases. RESULTS 236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies. CONCLUSION The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Maud Wieczorek
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, “Sf. Maria” Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland,Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana I Zlatković-Švenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Francis Guillemin
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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de Araújo Pereira F, de Almeida Lourenço M, de Assis MR. Evaluation of peripheral neuropathy in lower limbs of patients with rheumatoid arthritis and its relation to fall risk. Adv Rheumatol 2022; 62:9. [PMID: 35317839 PMCID: PMC8938971 DOI: 10.1186/s42358-022-00238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background Rheumatoid Arthritis (RA) is a chronic disabling systemic disease characterized by joint inflammation, and extra-articular manifestations, including peripheral neuropathy, a condition that can be associated with changes in muscle strength, proprioception and postural balance contributing for the risk of falls. The objective of this study is to analyze the incidence of peripheral neuropathy in patients with RA and its association with the occurrence of falls. Methods Patients were assessed by an electroneuromyography (ENMG) exam and by a questionnaire on accidental falls occurrence in the previous 12 months. They were also assessed on balance by the Short Physical Performance Battery (SPPB), functionality by the Health Assessment Questionnaire (HAQ), disease activity by the Disease Activity Score (DAS-28), neuropathic pain by the Questionnaire for the Diagnosis of Neuropathic Pain (DN4), and cutaneous sensitivity of the feet by the monofilament testing of Semmes–Weinstein. Monthly calls on falls were made in the subsequent six months. Data analysis was performed using the Shapiro–Wilk test for normality and Spearman, Chi-square, and T-student correlation tests, with a significant P level ≤ 0.05. Results A sample of 33 patients were evaluated. The incidence of peripheral neuropathy was 48.5%, of which 68.7% were axonal and 31.3% myelinic. The sensorimotor type was present in 64.7%, motor in 17.6%, and sensorial in 11.7% of the cases. Neuropathy was associated to balance (P = 0.026), neuropathic pain (P = 0.016), deep tendon reflexes absence (P = 0,049), altered skin sensitivity of the feet (P = 0.029) and fear of falling (P = 0.001). No association was found between peripheral neuropathy and age, gender, disease activity, or functionality. No significant association was found between peripheral neuropathy and occurrence of falls, in a 12-month retrospective and 6-month prospective evaluation. Conclusion Peripheral neuropathy has a high incidence in patients with RA, and is related to neuropathic pain, altered postural balance, but not to the occurrence of falls.
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Affiliation(s)
- Fabio de Araújo Pereira
- Neurology Department, Marilia Medical School (FAMEMA), 800 Monte Carmelo Avenue, Marília, SP, 17519030, Brazil.
| | - Mariana de Almeida Lourenço
- Physiotheraphy Departament, São Paulo State University (UNESP), 737 Hygino Muzzi Filho Avenue, Marília, SP, 17525-900, Brazil
| | - Marcos Renato de Assis
- Rheumathology Department, Marilia Medical School (FAMEMA), 800 Monte Carmelo Avenue, Marília, SP, 17519030, Brazil
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Furuya T. Clinical Observations of Osteoporosis in Japanese Patients with Rheumatoid Arthritis. Mod Rheumatol 2022; 32:839-845. [PMID: 34979563 DOI: 10.1093/mr/roab130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/15/2022]
Abstract
Osteoporosis is the one of the major adverse outcomes in patients with rheumatoid arthritis (RA). Recently, we and others have been reported many clinical observations related to osteoporosis in Japanese RA patients. In this article, I reviewed these findings. Japanese patients with RA have a two-fold risk of fractures compared with those without RA. Among the fractures in Japanese RA patients, three quarters of the fractures were non-vertebral fractures. The incidence of non-vertebral fractures did not change, despite an improvement in RA disease activity. Older age, female gender, history of fractures, history of total knee replacements, disease activity scores in 28 joints (DAS28), health assessment questionnaire disability index (HAQ-DI), low bone mineral density, glucocorticoid dose, and vitamin D deficiency were significantly associated with fractures. Older age, high body mass index (BMI), HAQ-DI, and polypharmacy were significantly associated with falls. BMI (both overweight and underweight), DAS28, and HAQ-DI were significantly associated with frailty. Half and three quarters of Japanese men and women with RA had vitamin D deficiency, respectively. The incidence of osteonecrosis of the jaw may be higher in Japanese RA patients than those without RA. Undertreatment of osteoporosis appears to exist in Japanese patients with RA.
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Affiliation(s)
- Takefumi Furuya
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Wakabayashi Clinic, Tokyo, Japan
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6
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Wiegmann S, Armbrecht G, Borucki D, Buehring B, Buttgereit F, Detzer C, Schaumburg D, Zeiner KN, Dietzel R. Association between sarcopenia, physical performance and falls in patients with rheumatoid arthritis: a 1-year prospective study. BMC Musculoskelet Disord 2021; 22:885. [PMID: 34663280 PMCID: PMC8524907 DOI: 10.1186/s12891-021-04605-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/05/2021] [Indexed: 01/07/2023] Open
Abstract
Background Patients with rheumatoid arthritis (RA) are at increased risk of falls and fractures. Sarcopenia occurs more frequently in RA patients due to the inflammatory processes. Early diagnosis and prevention programmes are essential to avoid serious complications. The present study aims to identify risk factors for falls related to sarcopenia and physical performance. Methods In a 1-year prospective study, a total of 289 patients with RA, ages 24–85 years, were followed using quarterly fall diaries to report falls. At the baseline, medical data such as RA disease duration and Disease Activity Score (DAS28CRP) were collected. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ). Appendicular skeletal mass was determined by Dual X-ray-Absorptiometry (DXA). Physical performance was evaluated by handgrip strength, gait speed, chair rise test, Short Physical Performance Battery, and FICSIT-4. Muscle mechanography was measured with the Leonardo Mechanograph®. Sarcopenia was assessed according to established definitions by the European Working Group on Sarcopenia in Older People (EWGSOP2) and The Foundation for the National Institutes of Health (FNIH). Univariate and multiple logistic regression analysis were used to explore associations with falling. Receiver-operating characteristics (ROC) were performed, and the area under the curve is reported. Results A total of 238 subjects with RA completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. No association was found between sarcopenia and prospective falls. Age (OR = 1.04, CI 1.01–1.07), HAQ (OR = 1.62, 1.1–2.38), and low FICSIT-4 score (OR = 2.38, 1.13–5.0) showed significant associations with falls. Conclusions In clinical practice, a fall assessment including age, self-reported activities of daily life and a physical performance measure can identify RA patients at risk of falling. Trial registration The study has been registered at the German Clinical Trials Register and the WHO International Clinical Trials Registry Platform (ICTRP) since 16 March 2017 (DRKS00011873).
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Affiliation(s)
- Sabine Wiegmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Klinik für Radiologie, Zentrum für Muskel- und Knochenforschung, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Gabriele Armbrecht
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Klinik für Radiologie, Zentrum für Muskel- und Knochenforschung, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Diana Borucki
- Deutsche Rheuma-Liga Bundesverband e.V, Welschnonnenstraße 7, 53111, Bonn, Germany
| | - Bjoern Buehring
- Rheumazentrum Ruhrgebiet, Ruhr-Universität-Bochum, Claudiusstr. 45, 44649, Herne, Germany
| | - Frank Buttgereit
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie u. Klinische Immunologie, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian Detzer
- Deutsche Rheuma-Liga Bundesverband e.V, Welschnonnenstraße 7, 53111, Bonn, Germany
| | - Désirée Schaumburg
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie u. Klinische Immunologie, Charitéplatz 1, 10117, Berlin, Germany
| | - Kim Nikola Zeiner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie u. Klinische Immunologie, Charitéplatz 1, 10117, Berlin, Germany.,Department of Dermatology, Venereology and Allergology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Roswitha Dietzel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Klinik für Radiologie, Zentrum für Muskel- und Knochenforschung, Hindenburgdamm 30, 12200, Berlin, Germany
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Furuya T, Oh K, Ikari K, Inoue E, Tanaka E, Yamanaka H, Harigai M. Factors associated with frailty in Japanese patients with rheumatoid arthritis: results from the Institute of Rheumatology Rheumatoid Arthritis cohort study. Clin Rheumatol 2021; 41:405-410. [PMID: 34586516 DOI: 10.1007/s10067-021-05938-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/01/2022]
Abstract
This study aimed to evaluate the prevalence of, and the factors associated with, frailty in Japanese patients with rheumatoid arthritis (RA). Patients with RA enrolled in the Institute of Rheumatology Rheumatoid Arthritis (IORRA) cohort completed self-administered questionnaires, which included the 5-item frailty screening index. Patients were classified as frail, prefrail, or robust based on the 5 components of the frailty screening index. Logistic regression analyses were used to evaluate associations between clinical variables and frailty. Among 3,290 Japanese patients with RA (86.7% female, mean age 62.4 years) who participated this frailty study, 549 (16.7%) patients were categorized as frailty, 2,063 (62.7%) as prefrailty, and 678 (20.6%) as robust. In multivariable models, body mass index (BMI) ≥ 25 kg/m2 (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.41 to 2.47), BMI < 18.5 kg/m2 (OR 1.31, 95% CI 1.00 to 1.71), disease activity scores in 28 joints (DAS28) (OR 1.32, 95% CI 1.18 to 1.47), Japanese version of Health Assessment Questionnaire disability index (J-HAQ) (OR 1.26, 95% CI 1.04 to 1.52), the European Quality of Life-5 Dimensions (EQ-5D) (OR 0.80, 95% CI 0.74 to 0.85), non-steroidal anti-inflammatory drug (NSAID) use (OR 1.59, 95% CI 1.23 to 1.98), and methotrexate (MTX) use (OR 0.75, 95% CI 0.60 to 0.94) were significantly (P < 0.05) associated with frailty. BMI (both overweight and underweight), DAS28, J-HAQ, EQ-5D, NSAID use, and MTX nonuse appear to be associated with frailty in Japanese patients with RA. Key Points • This is the largest study showing the prevalence and the associated factors of frailty in patients with RA. • Maintaining normal BMI appears to be important for preventing frailty in patients with RA. • We confirmed the significant associations of frailty with high disease activity, high degree of disability, and poor health related QOL in Japanese patients with RA. • NSAID use and MTX nonuse were associated with the frailty in Japanese patients with RA, which could be explained by patients' background.
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Affiliation(s)
- Takefumi Furuya
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. .,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
| | - Koei Oh
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,Department of Orthopedics, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,Department of Orthopedics, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Eiichi Tanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Hisashi Yamanaka
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,Rheumatology, Sanno Medical Center, Tokyo, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Analysis of the Associations between Arthritis and Fall Histories in Korean Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073758. [PMID: 33916869 PMCID: PMC8038444 DOI: 10.3390/ijerph18073758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 01/07/2023]
Abstract
(1) Background: the purpose of the present study was to analyze the associations between arthritis and fall histories in Korean adults. (2) Methods: data from the 2015 and 2017 Korean Community Health Survey were analyzed. In total, 322,962 participants aged ≥40 years were included. The participants were divided into two different groups. First, the participants were divided into the ‘arthritis (osteoarthritis or rheumatoid arthritis) for entire life’ and ‘nonarthritis for entire life (comparison I)’ groups. Subsequently, the participants were divided into the ‘current arthritis’ and ‘noncurrent arthritis (comparison II)’ groups. Afterwards, we analyzed the prevalence odds ratios (pORs) of the fall histories of the participants using a logistic regression analysis with the 95% confidence interval (CI). The variables of income, education level, region of residence, smoking status, alcohol consumption, obesity, subjective health status, stress level, physical activity, and sleep hours were adjusted for as covariates. (3) Results: both the arthritis for entire life and current arthritis groups had higher prevalence rates of falls than the comparison I and comparison II groups, respectively (each p < 0.001). The pORs of falling ≥1 time and ≥2 times per year in the arthritis for the entire life group were 1.42 (95% CI = 1.38–1.46) and 1.69 (95% CI = 1.62–1.76), respectively. The adjusted pORs for falling ≥1 time and ≥2 times per year in the current arthritis group were 1.35 (95% CI = 1.31–1.39) and 1.56 (95% CI = 1.50–1.63), respectively. (4) Conclusions: previous arthritis has a significant impact on the risk of falling.
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Stanmore EK, Oldham J, Skelton DA, O'Neill T, Pilling M, Todd C. Fear-of-falling and associated risk factors in persons with rheumatoid arthritis: a 1 year prospective study. BMC Musculoskelet Disord 2021; 22:260. [PMID: 33691660 PMCID: PMC7945213 DOI: 10.1186/s12891-021-04068-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background Falls, associated injuries and fear-of-falling are common in adults with RA. Fear-of-falling can be a major consequence of, and as debilitating as falling, resulting in a cycle of activity restriction, reduced quality of life, institutionalisation and potentially increase risk of falls. The objective of this study was to examine the relationship between fear-of-falling and risk factors associated with fear-of-falling in adults with rheumatoid arthritis (RA) over a 1 year period. Methods Five hundred fifty-nine patients with RA were recruited from four outpatient clinics in this prospective cohort study. Baseline assessments included socio-demographic, medical and lifestyle related risk factors. Fall incidence was prospectively obtained monthly using postal cards over a 1 year period. Fear-of-falling was assessed at baseline and 1 year using the Short Falls Efficacy Scale-International (Short FES-I). Logistic regression was used to determine the association between high fear-of-falling (Short FES-I > 11) at baseline (outcome) and a range of putative predictor variables including previous falls, and also baseline factors associated with a high fear-of-falling at follow-up. Results Five hundred thirty-five (ninety-six percent) participants (mean age 62.1 yrs.; 18–88 yrs) completed 1 year follow-up and of these, 254 (47%) completed the Short FES-I questionnaire at 1 year. In a multivariate model, a history of multiple falls (OR = 6.08) higher HAQ score (OR = 4.87) and increased time to complete the Chair Stand Test (OR = 1.11) were found to be independent predictors of high fear-of-falling and had an overall classification rate of 87.7%. There were no significant differences found in fear-of-falling at 1 year follow-up in those who reported falls during the study, participant’s baseline fear appeared to predict future fear, regardless of further falls. Conclusions Fear-of-falling is significantly associated with previous falls and predictive of future falls and fear. RA patients would benefit from fall prevention measures whether or not they have previously fallen.
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Affiliation(s)
- Emma K Stanmore
- School of Health Sciences and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, University Place, University of Manchester, Manchester, M13 9LP, UK. .,Manchester University NHS Foundation Trust, M13 9WL, Manchester, UK.
| | - Jackie Oldham
- School of Health Sciences, Citylabs, Nelson Street, University of Manchester, Manchester, M13 9LP, UK
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, UK
| | - Terence O'Neill
- Versus Arthritis Centre for Epidemiology and Centre for Musculoskeletal Research, University of Manchester, Manchester, M13 9PT, UK.,Department of Rheumatology, Salford Royal National Health Service Foundation Trust, Salford, M6 8HD, UK
| | - Mark Pilling
- Behaviour and Health Research Unit, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Chris Todd
- School of Health Sciences and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, University Place, University of Manchester, Manchester, M13 9LP, UK
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10
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Alkady EA, Abdelaziz MM, Abdelwahed D, Mahran SA. Falls in Rheumatoid Patients: Does Ankle and Foot Ultrasonography have a Predictive Role? A Single-blind Study. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1353-4415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABSTRACT
Background Rheumatoid arthritis (RA) patients have a higher prevalence of falls compared with the healthy population. Several risk factors of falls in RA have been postulated, including high disease activity, low balance, muscle weakness and non-treatment with biologics.
Aim of the work We investigated our hypothesis that the sonographically detected ankle and foot changes in RA patients can predict falls in this population. To our knowledge, no previous study had investigated this before.
Methods In a total of 101 RA patients, we performed assessments of disease activity, disability level, gait speed, balance status, clinical examination of ankle and foot and an MSUS assessment of the ankle and foot joints and tendons as possible risk factors of falls.
Results The Berg balance test had the highest fall-predicting power (71.3%), followed by a gait speed test and restricted range of motion (ROM) of the Rt. subtalar joint, each with a predictive power of 70.3%. Of the sonographic findings, erosion of the first metatarsophalangeal (MTP) joint was the most accurate fall predictor, followed by erosion of the talonavicular joint and tenosynovitis of the ankle dorsal flexors with an area under the curve of 0.656, 0.642 and 0.614, respectively.
Conclusion The use of the MSUS as an adjunct objective method for predicting falls in RA patients has not been studied before. It was found that clinical foot and balance testing was a superior and easier way of predicting falls in RA patients than using ultrasonography.
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Affiliation(s)
- Eman A.M. Alkady
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University Faculty of Medicine, Assiut, Egypt
| | - Marwa Mahmoud Abdelaziz
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University Faculty of Medicine, Assiut, Egypt
| | - Dalia Abdelwahed
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University Faculty of Medicine, Assiut, Egypt
| | - Safaa A. Mahran
- Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University Faculty of Medicine, Assiut, Egypt
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11
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Oh K, Furuya T, Ikari K, Inoue E, Tanaka E, Yamanaka H, Okazaki K, Harigai M. Polypharmacy, declined walking speed, bent back, and disability associated with a history of falls in Japanese patients with rheumatoid arthritis: Results from the IORRA cohort study. Mod Rheumatol 2020; 31:764-767. [PMID: 32812455 DOI: 10.1080/14397595.2020.1812200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Koei Oh
- Department of Orthopedics, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takefumi Furuya
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedics, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Eiichi Tanaka
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hisashi Yamanaka
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Rheumatology, Sanno Medical Center, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedics, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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12
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Nakayama M, Furuya T, Inoue E, Tanaka E, Ikari K, Taniguchi A, Yamanaka H, Harigai M. Factors associated with osteoporosis medication use in Japanese patients with rheumatoid arthritis: Results from the Institute of Rheumatology Rheumatoid Arthritis cohort study. Osteoporos Sarcopenia 2020; 6:82-87. [PMID: 32715099 PMCID: PMC7374244 DOI: 10.1016/j.afos.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/11/2020] [Accepted: 04/27/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives This study aimed to evaluate factors associated with osteoporosis medication use in Japanese patients with rheumatoid arthritis (RA). Methods Patients with RA who enrolled in our cohort completed self-administered questionnaires which included questions regarding their osteoporosis medications. Logistic regression was used to determine the association of variables with the use of these medications. Results Among 5660 Japanese patients with RA who responded to the questionnaires (mean age, 61.8 years; 86.0% female), 1983 patients (35.0%) and 1211 patients (21.4%) reported taking osteoporosis medications and antiresorptive agents, respectively. In multivariate models, age, female sex, lower body mass index (BMI), self-reported fracture history, Japanese Health Assessment Questionnaire-Disability Index (JHAQ-DI), daily dosage of prednisone (PSL), weekly dosage of methotrexate (MTX), and concomitant use of hypertension and hyperlipidemia medications were significantly associated with the use of osteoporosis medications (P < 0.05). Among women with RA, the use of hypertension medications was significantly correlated with the use of both osteoporosis medications and antiresorptive agents (P < 0.05). Conclusions Age, female sex, a lower BMI, duration of RA, self-reported fracture history, JHAQ-DI, daily dosage of PSL, weekly dosage of MTX, and the use of medications for hypertension and hyperlipidemia appear to be associated with the use of osteoporosis medications in Japanese patients with RA.
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Affiliation(s)
- Masanori Nakayama
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Chiba, Japan
| | - Takefumi Furuya
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Eisuke Inoue
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan.,Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Eiichi Tanaka
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuo Taniguchi
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisahi Yamanaka
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan.,Rheumatology, Sanno Medical Center, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
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13
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Mikos M, Kucharska E, Lulek AM, Kłosiński M, Batko B. Evaluation of Risk Factors for Falls in Patients with Rheumatoid Arthritis. Med Sci Monit 2020; 26:e921862. [PMID: 32292180 PMCID: PMC7177037 DOI: 10.12659/msm.921862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background The aim of our study was to investigate the risk factors for falls in the rheumatoid arthritis (RA) patient population in Poland. This would be a major step towards the development of new fall prevention programs. Material/Methods There were 450 RA patients who met the criteria of the American College of Rheumatology who participated in this study. The average age of patient participants was 54.2 years; the average RA duration was 15.1 years. All patients filled out the study questionnaire regarding falls, medications, and diseases, and they filled out the Polish version of the Health Assessment Questionnaire (HAQ). Results Of the 400 patients, 203 patients (51%) experienced falls. Out of the 268 falls experienced by study patients, 113 falls (42%) were due to an environmental cause, the remainder 155 falls were caused by health conditions. The number of falls positively correlated with HAQ scores (r=0.42, P<0.01) and the duration of RA (r=0.39, P<0.05). For individuals who had fallen 3 or more times, there was a stronger positive correlation between the number of falls and the total HAQ score (r=0.61, P<0.01). The main risk factors for falls in the study group were dizziness (odds ratio [OR]=3.42), the use of hypotensive medication (OR=2.82), foot deformities (OR=4.09), and a high HAQ score (OR=2.59). Other factors such as drug use (e.g., glucocorticoids), pain, and duration of RA were measured using a visual analogue scale, and were found not to have increased the risk for falls and fractures (P>0.05). Conclusions Knowledge about risk factors can help identify high-risk patients to help decrease their risk of falling, thus preventing fall-related injuries.
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Affiliation(s)
- Marcin Mikos
- Department of Emergency Medical Services, Faculty of Medicine, The Andrzej Frycz Modrzewski Cracow University, Cracow, Poland
| | - Ewa Kucharska
- Department of Gerontology, Geriatrics and Social Work, Faculty of Education, The Ignatianum Academy, Cracow, Poland
| | - Anna Maria Lulek
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Kłosiński
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.,Department of Rheumatology, The J. Dietl Specialist Hospital Cracow, Cracow, Poland
| | - Bogdan Batko
- Department of Rheumatology, The J. Dietl Specialist Hospital Cracow, Cracow, Poland
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14
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Oh K, Furuya T, Inoue E, Tanaka E, Ikari K, Taniguchi A, Yamanaka H, Okazaki K, Harigai M. A simple screening test to assess risk of falls in Japanese patients with rheumatoid arthritis: Results from the IORRA cohort study. Mod Rheumatol 2020; 31:506-509. [PMID: 32202187 DOI: 10.1080/14397595.2020.1746016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Koei Oh
- Department of Orthopedics, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takefumi Furuya
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Division of Medical Informatics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Eiichi Tanaka
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedics, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Atsuo Taniguchi
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hisashi Yamanaka
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Department of Rheumatology, Sanno Medical Center, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedics, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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15
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Clynes MA, Jameson K, Prieto-Alhambra D, Harvey NC, Cooper C, Dennison EM. Impact of Rheumatoid Arthritis and Its Management on Falls, Fracture and Bone Mineral Density in UK Biobank. Front Endocrinol (Lausanne) 2019; 10:817. [PMID: 31849841 PMCID: PMC6888088 DOI: 10.3389/fendo.2019.00817] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/08/2019] [Indexed: 01/10/2023] Open
Abstract
Objectives: Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease which presents with polyarthritis in addition to extra-articular manifestations. Historically, studies have shown a link between RA and adverse musculoskeletal outcomes but these studies were reported before the widespread use of biologic therapies. The aim of this study was therefore to investigate associations between RA, RA medications and bone mineral density, falls and fractures, using UK Biobank data. Methods: Diagnosis of RA was made using Hospital Episode Statistics (HES) ICD-10 coding. We assessed RA relationships with estimated bone mineral density (eBMD) from heel quantitative ultrasound measurements, self-reported falls (in last year) and HES recorded fracture, adjusted for age, ethnicity, BMI, smoking status, and physical activity. Results: Of 502,543 participants, 3849 (1.4%) of women and 1643 (0.7%) of men had a diagnosis of RA. Median age of the participants was 57 years (IQR 50-63) in women and 58 (IQR 50-64) in men. RA was associated with lower eBMD (men: β -0.244, 95% CI -0.378, -0.110 p < 0.001; women: β -0.217, 95% CI -0.297, -0.138 p < 0.001) a reported fall in the last year (men: OR 1.54, 95% CI 1.26, 1.87 p < 0.001; women: OR 1.36, 95% CI 1.19, 1.56 p < 0.001) and fracture in women (OR 1.76, 95% CI 1.43, 2.16 p < 0.001). Corticosteroid therapy in men (β -0.934, 95% CI -1.565, -0.304 p = 0.004) and disease modifying anti-rheumatic drug (DMARD) use in both sexes (men: β -0.437, 95% CI -0.761, -0.112 p = 0.008; women: β -0.243, 95% CI -0.421, -0.065 p = 0.007), but not biologic therapy, were associated with a lower eBMD with RA. Conclusions: RA was associated with lower eBMD, increased falls and fracture. Corticosteroid and DMARD therapy, but not biologic therapy, were associated with lower eBMD.
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Affiliation(s)
- Michael A. Clynes
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Karen Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | | | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
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16
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Welsh VK, Clarson LE, Mallen CD, McBeth J. Multisite pain and self-reported falls in older people: systematic review and meta-analysis. Arthritis Res Ther 2019; 21:67. [PMID: 30795790 PMCID: PMC6387492 DOI: 10.1186/s13075-019-1847-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background Multisite pain and falls are common in older people, and isolated studies have identified multisite pain as a potential falls risk factor. This study aims to synthesise published literature to further explore the relationship between multisite pain and falls and to quantify associated risks. Methods Bibliographic databases were searched from inception to December 2017. Studies of community-dwelling adults aged 50 years and older with a multisite pain measurement and a falls outcome were included. Two reviewers screened articles, undertook quality assessment and extracted data. Random-effects meta-analysis was used to pool the effect estimate (odds ratio (OR) and 95% confidence interval (95%CI)). Heterogeneity was assessed by I2; sensitivity analyses used adjusted risk estimates and exclusively longitudinal studies. Results The search identified 49,577 articles, 3145 underwent abstract review, 22 articles were included in the systematic review and 18 were included in the meta-analysis. The unadjusted pooled OR of 1.82 (95%CI 1.55–2.13), demonstrating that those reporting multisite pain are at increased risk of falls, is supported by the adjusted pooled OR of 1.56 (95%CI 1.39–1.74). Multisite pain predicts future falls risk (OR = 1.74 (95%CI 1.57–1.93)). For high-quality studies, those reporting multisite pain have double the odds of a future fall compared to their pain-free counterparts. Conclusion Multisite pain is associated with an increased future falls risk in community-dwelling older people. Increasing public awareness of multisite pain as a falls risk factor and advising health and social care professionals to identify older people with multisite pain to signpost accordingly will enable timely falls prevention strategies to be implemented. Electronic supplementary material The online version of this article (10.1186/s13075-019-1847-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Victoria K Welsh
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Lorna E Clarson
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT, UK
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17
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Zonzini Gaino J, Barros Bértolo M, Silva Nunes C, de Morais Barbosa C, Sachetto Z, Davitt M, de Paiva Magalhães E. Disease-related outcomes influence prevalence of falls in people with rheumatoid arthritis. Ann Phys Rehabil Med 2018; 62:84-91. [PMID: 30278237 DOI: 10.1016/j.rehab.2018.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/03/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) are at increased risk of falls, with potential adverse outcomes. There is a considerable variation across studies regarding the prevalence of falls and its correlation with clinical data, disease-related outcomes and physical performance tests. OBJECTIVE The aim of this study was to evaluate the prevalence of falls and its association with clinical data, disease-related outcomes and physical performance tests. METHODS In this cross-sectional study, 113 RA patients were divided into 3 groups - "non-fallers", "sporadic fallers" and "recurrent fallers" - and compared in terms of clinical data, Clinical Disease Activity Index (CDAI), lower-limb tender and swollen joint count, disability (Health Assessment Questionnaire-Disability Index [HAQ-DI]), Foot Function Index (FFI), Berg Balance Scale (BBS), Timed-up-and-go Test (TUG) and 5-Time Sit Down-To-Stand Up Test (SST5). Logistic regression analysis was performed to analyze the associations between the studied variables and the occurrence of falls, estimating odds ratios (ORs). We also analyzed the correlation between disease outcome measures (HAQ-DI and CDAI) and physical tests (BBS, TUG, SST5). RESULTS Falls and fear of falling were reported by 59 (52.21%) and 71 (64.5%) patients, respectively. Significant associations were found between "recurrent fallers" and vertigo (OR=3.42; P=0.03), fear of falling (OR=3.44; P=0.01), low income (OR=2.02; P=0.04), CDAI (OR=1.08; P<0.01), HAQ-DI (OR=3.66; P<0.01), Lower-limb HAQ (OR=3.48; P<0.01), FFI-pain (OR=1.24; P=0.03), FFI-total (OR=1.23; P=0.04), lower-limb tender joint count (OR=1.22; P<0.01), BBS score (OR=1.14; P<0.01), TUG score (OR=1.13; P=0.03) and SST5 score (OR=1.06; P=0.02). On multivariate analysis, CDAI was the only significant predictor of recurrent falls (OR=1.08; P<0.01). Physical performance test scores (BBS, TUG, SST5) were correlated with the CDAI and HAQ-DI. CONCLUSION The prevalence of falls in RA is high, most influenced by disease-related outcomes and linked to worse performance on physical tests (BBS, TUG and SST5).
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Affiliation(s)
- J Zonzini Gaino
- Department of internal medicine, rheumatology, faculty of medical sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - M Barros Bértolo
- Department of internal medicine, rheumatology, faculty of medical sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - C Silva Nunes
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - C de Morais Barbosa
- Department of internal medicine, gerontology, faculty of medical sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Z Sachetto
- Department of internal medicine, rheumatology, faculty of medical sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - M Davitt
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - E de Paiva Magalhães
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil.
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18
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Torii M, Hashimoto M, Hanai A, Fujii T, Furu M, Ito H, Uozumi R, Hamaguchi M, Terao C, Yamamoto W, Uda M, Nin K, Morita S, Arai H, Mimori T. Prevalence and factors associated with sarcopenia in patients with rheumatoid arthritis. Mod Rheumatol 2018; 29:589-595. [PMID: 30092163 DOI: 10.1080/14397595.2018.1510565] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives: Sarcopenia is characterized by loss of muscle strength and mass, leading to falls and adverse health outcomes. Our aim was to determine the prevalence of sarcopenia in patients with rheumatoid arthritis (RA) and to identify factors associated with sarcopenia in these patients. Methods: A cross-sectional study of 388 consecutive women with RA was conducted, assessing muscle mass and strength, and walking speed. Falls and bone fractures sustained over the prior year were evaluated. The association between sarcopenia and RA characteristics, falls, and bone fractures was evaluated using logistic regression analyses. Results: The prevalence of sarcopenia was 37.1% (14.7%, severe sarcopenia; 22.4%, sarcopenia), with 49.0% classified as having low muscle mass. The incidence of falls, fractures, and lower bone mineral density was higher in patients with than without sarcopenia. Age, RA duration, Steinbrocker's stage, the high Mini-Nutritional Assessment-Short Form score and the use of biological disease-modifying anti-rheumatic drugs (bDMARDs) were independent factors associated with sarcopenia. Conclusion: We confirmed that sarcopenia develops in a significant proportion of patients with RA. Age, longer disease duration, joint destruction and malnutrition were positively associated with sarcopenia, with the use of bDMARDs being negatively associated.
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Affiliation(s)
- Mie Torii
- a Department of Human Health Sciences, Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Motomu Hashimoto
- b Department of the Control for Rheumatic Diseases, Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Akiko Hanai
- a Department of Human Health Sciences, Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Takao Fujii
- b Department of the Control for Rheumatic Diseases, Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Moritoshi Furu
- b Department of the Control for Rheumatic Diseases, Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Hiromu Ito
- b Department of the Control for Rheumatic Diseases, Graduate School of Medicine , Kyoto University , Kyoto , Japan.,c Department of Orthopedic Surgery, Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Ryuji Uozumi
- d Department of Biomedical and Bioinformatics, Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Masahide Hamaguchi
- e Department of Endocrinology and Metabolism, Graduate School of Medicine , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Chikashi Terao
- f Unit of Human Disease Genomics Center for Genomic Medicine, Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Wataru Yamamoto
- b Department of the Control for Rheumatic Diseases, Graduate School of Medicine , Kyoto University , Kyoto , Japan.,g Department of Health Information Management , Kurashiki Sweet Hospital , Kurashiki , Japan
| | - Miyabi Uda
- a Department of Human Health Sciences, Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Kazuko Nin
- a Department of Human Health Sciences, Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Satoshi Morita
- d Department of Biomedical and Bioinformatics, Graduate School of Medicine , Kyoto University , Kyoto , Japan
| | - Hidenori Arai
- h National Center for Geriatrics and Gerontology , Obu , Japan
| | - Tsuneyo Mimori
- b Department of the Control for Rheumatic Diseases, Graduate School of Medicine , Kyoto University , Kyoto , Japan.,i Department of Rheumatology and Clinical Immunology, Graduate School of Medicine , Kyoto University , Kyoto , Japan
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Lourenço MDA, Carli FVBO, de Assis MR. Characterization of falls in adults with established rheumatoid arthritis and associated factors. Adv Rheumatol 2018; 58:16. [DOI: 10.1186/s42358-018-0021-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
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Abdulrazaq S, Oldham J, Skelton DA, O'Neill T, Munford L, Gannon B, Pilling M, Todd C, Stanmore EK. A prospective cohort study measuring cost-benefit analysis of the Otago Exercise Programme in community dwelling adults with rheumatoid arthritis. BMC Health Serv Res 2018; 18:574. [PMID: 30029649 PMCID: PMC6053737 DOI: 10.1186/s12913-018-3383-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background Falls are one of the major health problems in adults with Rheumatoid Arthritis (RA). Interventions, such as the Otago Exercise Programme (OEP), can reduce falls in community dwelling adults by up to 35%. The cost-benefits of such a programme in adults with RA have not been studied. The aims of this study were to determine the healthcare cost of falls in adults with RA, and estimate whether it may be cost efficient to roll out the OEP to improve function and prevent falls in adults living with RA. Methods Patients with Rheumatoid Arthritis aged ≥18 years were recruited from four rheumatology clinics across the Northwest of England. Participants were followed up for 1 year with monthly fall calendars, telephone calls and self-report questionnaires. Estimated medical cost of a fall-related injury incurred per-person were calculated and compared with OEP implementation costs to establish potential economic benefits. Results Five hundred thirty-five patients were recruited and 598 falls were reported by 195 patients. Cumulative medical costs resulting from all injury leading to hospital services is £374,354 (US$540,485). Average estimated cost per fall is £1120 (US$1617). Estimated cost of implementing the OEP for 535 people is £116,479 (US$168,504) or £217.72 (US$314.34) per-person. Based on effectiveness of the OEP it can be estimated that out of the 598 falls, 209 falls would be prevented. This suggests that £234,583 (US$338,116) savings could be made, a net benefit of £118,104 (US$170,623). Conclusions Implementation of the OEP programme for patients with RA has potentially significant economic benefits and should be considered for patients with the condition.
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Affiliation(s)
- Siyar Abdulrazaq
- E K Stanmore School of Nursing, Midwifery and Social Work, MAHSC (Manchester Academic Health Science Centre), University of Manchester, Jean McFarlane Building, University Place, Manchester, M13 9PL, UK
| | - Jackie Oldham
- Arthritis Research UK Centre for Epidemiology & NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, UK
| | - Terence O'Neill
- Arthritis Research UK Centre for Epidemiology & NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Luke Munford
- Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, M13 9PL, UK
| | - Brenda Gannon
- Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, M13 9PL, UK
| | - Mark Pilling
- E K Stanmore School of Nursing, Midwifery and Social Work, MAHSC (Manchester Academic Health Science Centre), University of Manchester, Jean McFarlane Building, University Place, Manchester, M13 9PL, UK
| | - Chris Todd
- E K Stanmore School of Nursing, Midwifery and Social Work, MAHSC (Manchester Academic Health Science Centre), University of Manchester, Jean McFarlane Building, University Place, Manchester, M13 9PL, UK
| | - Emma K Stanmore
- E K Stanmore School of Nursing, Midwifery and Social Work, MAHSC (Manchester Academic Health Science Centre), University of Manchester, Jean McFarlane Building, University Place, Manchester, M13 9PL, UK.
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Falls, fear of falling, and associated factors in ambulatory patients with rheumatoid arthritis: A comparative study with healthy controls. Turk J Phys Med Rehabil 2018; 64:213-221. [PMID: 31453514 DOI: 10.5606/tftrd.2018.1687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/17/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to compare fall history and fear of falling (FOF) in patients with rheumatoid arthritis (RA) and healthy controls and to evaluate associated factors for fall risk and FOF in patients with RA. Materials and methods Between March 2016 and July 2016, a total of 120 patients with RA and 60 age- and sex-matched healthy volunteers were included in the study. The presence of FOF (Yes/No), fall history, and the number of falls within the past 12 month were questioned. All participants were assessed with the Falls Efficacy Scale-International (FES-I), 10 Meter Walk Test (10MWT), One-Leg Stand Test (OLST), Berg Balance Scale (BBS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Pain Severity and Patient Global Assessment (PGA) by Visual Analog Scale (VAS), disability by the Health Assessment Questionnaire (HAQ), and disease activity by Disease Activity Score in 28 joints (DAS28) were evaluated in patients with RA. Results There was no statistically difference between the RA patients and healthy controls in terms of presence of fall history, while the presence of FOF and FES-I scores were significantly higher in the RA patients (p<0.05). In the patient group, the FES-I score was positively correlated with pain VAS, PGA, DAS-28, HAQ, BAI, BDI, and 10MWT and negatively BBS and OLST (p<0.05). The number of falls, HAQ, BBS, and BDI scores were found to be significant independent risk factors affecting variations in the FES-I scores (p<0.001). Conclusion Fear of falling seems to be an important problem in patients with RA, and patients without fall history may also have FOF. The most important factors associated with FOF were impaired balance, increased disability and depression, and number of falls in RA patients. Strategies for preventing falls, maintaining balance, improving emotional status and against FOF are of utmost importance in patients with RA.
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Nakayama M, Furuya T, Inoue E, Tanaka E, Ikari K, Nakajima A, Taniguchi A, Yamanaka H. Factors associated with decreasing serum 25(OH)D among Japanese patients with rheumatoid arthritis: Results from the IORRA cohort study. Mod Rheumatol 2018; 29:430-435. [DOI: 10.1080/14397595.2018.1481727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Masanori Nakayama
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Takefumi Furuya
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Eisuke Inoue
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
- Division of Medical Informatics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Eiichi Tanaka
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Ayako Nakajima
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Atsuo Taniguchi
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
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Brenton-Rule A, Dalbeth N, Menz HB, Bassett S, Rome K. Are Foot and Ankle Characteristics Associated With Falls in People With Rheumatoid Arthritis? A Prospective Study. Arthritis Care Res (Hoboken) 2017; 69:1150-1155. [PMID: 27768838 DOI: 10.1002/acr.23131] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/03/2016] [Accepted: 10/18/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine whether foot and ankle characteristics are associated with falls in people with rheumatoid arthritis (RA). METHODS A total of 201 adults with RA were recruited from rheumatology outpatient clinics in Auckland, New Zealand. Clinical characteristics, common fall risk factors, and foot and ankle variables were measured. Participants were prospectively studied for 12 months to record the occurrence of falls using falls diaries. Logistic regression analysis identified baseline variables that were independent predictors of falls over the 12 months. RESULTS Eighty-four participants (42%) fell at least once and 39 (19%) experienced multiple (>1) falls over the 12-month followup period. In logistic regression analysis, including age and significant baseline variables in bivariate analysis but not baseline fall history, presence of foot or ankle tender joints (odds ratio [OR] 1.95, P = 0.034) and psychotropic medication (OR 2.35, P = 0.025) were independent predictors of prospective falls. However, when baseline fall history was included in the analysis, psychotropic medication (OR 2.34, P = 0.025) and baseline fall history (over the preceding 12 months) (OR 2.27, P = 0.008) were independent predictors of prospective falls. CONCLUSION Foot and ankle characteristics are not associated with falls in people with RA, independent of prior falls. Inquiry about prior falls and psychotropic medications may assist in identifying patients with RA who are at high risk of future falls.
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Affiliation(s)
| | | | | | - Sandra Bassett
- Auckland University of Technology, Auckland, New Zealand
| | - Keith Rome
- Auckland University of Technology, Auckland, New Zealand
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Ocorrência de quedas e sua associação com testes físicos, capacidade funcional e aspectos clínicos e demográficos em pacientes com artrite reumatoide. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Fall Risk and Related Factors in Systemic Lupus Erythematosus. Arch Rheumatol 2017; 32:216-220. [PMID: 30375549 DOI: 10.5606/archrheumatol.2017.6079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/19/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to determine the fall risk in systemic lupus erythematosus (SLE) patients with an objective computerized technique and to evaluate the potential related risk factors for falls in these patients. Patients and methods A total of 48 female patients (mean age 37.8±12.6 years; range 18 to 65 years) with SLE and 30 female controls (mean age 39.1±15.7 years; range 19 to 66 years) were included. Age, disease duration, anamnesis of falls, fear of falling, and drugs used were recorded. Disease activity (measured with SLE disease activity index Safety of Estrogens in Lupus Erythematosus National Assessment modification) and damage (measured with Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) were evaluated. For the evaluation of fall efficacy, we used the Falls Efficacy Scale International. Fall risk analysis was performed by using a computerized posturography device. Results Seven patients (15%) had anamnesis of falls during the last 12 months, whereas only one control (3%) had this anamnesis (p=0.042). Fear of falling was reported by 40% of the patients and 30% of the controls (p=0.042). Falls Efficacy Scale International scores were found to be higher in patients than in controls (p=0.042). With the computerized system used, higher fall risk results were recorded in patients than in controls (59.3±29.5 and 35.8±26.9, respectively; p<0.001). Low, moderate, and high fall risks were recorded as 31%, 15%, and 54% in the patients, respectively, and as 53%, 23%, and 23% in the controls, respectively. Low, moderate and high fall risk distribution was also worse in patients than in the controls (p=0.030). No significant correlation was found between fall risk and the other factors evaluated, except Falls Efficacy Scale International, which was significantly correlated with both fall risk assessment and fall risk category in the patients (r=0.311, p=0.031). Conclusion Fall risk was found to be higher in SLE patients than in controls. The higher fall risk in these patients seems to be affected by the disease itself rather than its other characteristics. Future studies investigating the possible coexisting balance problems in SLE may contribute to the management of the disease.
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Oh E, Hong GRS, Lee S, Han S. Fear of falling and its predictors among community-living older adults in Korea. Aging Ment Health 2017; 21:369-378. [PMID: 26479777 DOI: 10.1080/13607863.2015.1099034] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To explore the prevalence and predicting factors of fear of falling (FOF) among community-living older adults in Korea. METHODS Secondary data analysis of the 2011 Korean National Elderly Living Conditions and Welfare Desire Survey was used. Logistic regression analysis was conducted to examine the predictors of FOF. RESULTS In total, 75.6% of older adults with normal cognition have FOF. Factors associated with an increased risk of FOF in older adults are previous experience with falling (OR = 3.734, 95% CI = 2.996-4.655), limitations in the performance of exercise involving lower extremities (OR = 2.428, 95% CI = 2.063-2.858), being female (OR = 2.335, 95% CI = 2.023-2.694), having more than three chronic diseases (OR = 1.994, 95% CI = 1.625-2.446), limitations in instrumental activities of daily living (IADLs) (OR = 1.745, 95% CI = 1.230-2.477), limitations in the performance of exercise involving upper extremities (OR = 1.646, 95% CI = 1.357-1.997), living without a spouse (OR = 1.626, 95% CI = 1.357-1.948), having poor self-rated health (OR = 1.571, 95% CI = 1.356-1.821), limitations in muscle strength (OR = 1.455, 95% CI = 1.150-1.841), age (≥75 years) (OR = 1.320, 95% CI = 1.150-1.516), lower levels of education (0-6 years) (OR = 1.231, 95% CI = 1.075-1.409), and life satisfaction (OR = 1.104, 95% CI = 1.065-1.114). CONCLUSION A multidimensional construct of general characteristics, physical, and psychosocial variables act as risk factors for FOF. Preventive intervention should be developed to decrease the FOF among Korean older adults.
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Affiliation(s)
- Eunmi Oh
- a College of Nursing , Hanyang University , Seoul , Korea
| | | | - Seonhye Lee
- b Department of Nursing , Gyeongnam National University of Science and Technology , Jinju , Korea
| | - Soojeong Han
- c School of Nursing , Columbia University , NY , USA
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Lourenço MDA, Roma I, Assis MRD. Falls and their association with physical tests, functional capacity, clinical and demographic factors in patients with rheumatoid arthritis. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 57:217-223. [PMID: 28535893 DOI: 10.1016/j.rbre.2016.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 08/03/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the occurrence of falls reported by rheumatoid arthritis patients and its relation to disease activity, functional capacity and physical fitness. MATERIALS AND METHODS A cross-sectional study constituted by a sample of 97 rheumatoid arthritis patients from the city of Marília (SP) from 2012 to 2013, were assessed for disease activity. Instruments validated for Brazilian population in order to evaluate physical and functional capacity were used. Data analysis was carried out with descriptive statistics, Spearman correlation and Chi-squared test, considering p<0.05. RESULTS 88.7% were female subjects with a mean age of 56 (±11.7) years. The median duration of rheumatoid arthritis was 10 years (P25=6 and P75=17) and the mean of disease activity was 3.6 (±1.3), what was considered a moderate activity. In the last 12 months 37.1% of patients experienced at least one fall, with a total of 52 episodes, and fear of falling was reported by 74.2% of them, but this was not associated to the occurrence of a fall (χ2=1.19, p=0.27). Gender, number of medications, age, disease activity, duration of rheumatoid arthritis, functional capacity, and physical tests showed no associations with history of falls in the past year. CONCLUSION It was observed that the occurrence of falls and the fear of falling are quite common in this population. The occurrence of falls in this sample of rheumatoid arthritis patients bears no relation to disease activity, functional capacity, or physical fitness tests.
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Affiliation(s)
| | - Izabela Roma
- Faculdade de Medicina de Marília (Famema), Marília, SP, Brazil
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Mamoto K, Inui K, Okano T, Sugioka Y, Tada M, Koike T, Nakamura H. Incidence rate of falls and its risk factors in patients with rheumatoid arthritis compared to controls: Four years of the TOMORROW study. Mod Rheumatol 2016; 27:8-14. [DOI: 10.1080/14397595.2016.1176625] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | - Yuko Sugioka
- Center for Senile Degenerative Disorders (CSDD), Osaka City University Medical School, Osaka, Japan, and
| | | | - Tatsuya Koike
- Center for Senile Degenerative Disorders (CSDD), Osaka City University Medical School, Osaka, Japan, and
- Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, Wakayama, Japan
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Brenton-Rule A, Dalbeth N, Menz HB, Bassett S, Rome K. Foot and ankle characteristics associated with falls in adults with established rheumatoid arthritis: a cross-sectional study. BMC Musculoskelet Disord 2016; 17:22. [PMID: 26762210 PMCID: PMC4712600 DOI: 10.1186/s12891-016-0888-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 01/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with rheumatoid arthritis (RA) have an increased risk of falls. The foot is a common site of pathology in RA and foot problems are reported in up to 90% of patients with established disease. The aim of this study was to determine whether foot and ankle characteristics are associated with falls in people with RA. METHODS Adults with RA were recruited from rheumatology outpatient clinics in Auckland, New Zealand. Participants reported whether they had fallen in the preceding year, and the number of falls. Clinical characteristics, common fall risk factors, and foot and ankle variables were measured. Univariate parametric and non-parametric analysis compared fallers and non-fallers on all variables to determine significant differences. Logistic regression analysis identified variables independently associated with falls. RESULTS Two hundred and one participants were prospectively recruited. At least one fall in the preceding 12-months was reported by 119 (59%) participants. Univariate analysis showed that fallers had significantly longer mean disease duration, more co-morbid conditions, an increase in lower limb tender joints, higher midfoot peak plantar pressures and were more likely to have a history of vascular disease than non-fallers. Fallers also reported greater difficulty with activities of daily living, increased fear of falling and greater self-reported foot impairment. Logistic regression analysis revealed that increased midfoot peak plantar pressures (odds ratio (OR) 1.12 [for each 20 kPa increase], 95% confidence interval (CI) 1.00-1.25), self-reported foot impairment (OR 1.17 [for each three point increase], 95% CI 1.05-1.31) and history of vascular disease (OR 3.22, 95% CI 1.17-8.88) were independently associated with a fall in the preceding 12 months. CONCLUSIONS Elevated midfoot peak plantar pressures, self-reported foot impairment and vascular disease are associated with falls in people with RA. Assessment of foot deformity, foot function and self-reported foot impairment may be of benefit when considering falls prevention strategies in people with RA. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry (trial ACTRN12612000597897).
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Affiliation(s)
| | - Nicola Dalbeth
- University of Auckland, Private Bag 92-019, Auckland, New Zealand
| | - Hylton B Menz
- La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Sandra Bassett
- AUT University, Private Bag 92006, Auckland, 1142, New Zealand
| | - Keith Rome
- AUT University, Private Bag 92006, Auckland, 1142, New Zealand
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Morpeth T, Brenton-Rule A, Carroll M, Frecklington M, Rome K. Fear of falling and foot pain, impairment and disability in rheumatoid arthritis: a case-control study. Clin Rheumatol 2015; 35:887-91. [PMID: 26592931 DOI: 10.1007/s10067-015-3124-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/04/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
Fear of falling, foot pain, impairment and disability are commonly reported in rheumatoid arthritis (RA). However, the relationship between fear of falling and foot pain, impairment and disability has not been investigated in established RA. The aim of the study was to evaluate the relationship between fear of falling and foot pain, walking velocity and foot impairment and disability in women with established RA. A secondary aim was to evaluate differences between fear of falling, foot pain, walking velocity and foot impairment and disability in women with established RA and age- and sex-matched control participants. Twenty-one women with established RA and twenty-one age- and sex-matched controls were assessed for fear of falling, foot pain, foot impairment and disability and walking velocity. Pearson's r-correlations were used to examine relationships between fear of falling and the foot measures. Independent samples t tests evaluated the differences in fear of falling and foot measures between the two groups. In people with RA, significant correlations were found between fear of falling and foot impairment (r = 0.53, p = 0.015), foot disability (r = 0.77, p <0.001) and walking velocity (r = 0.56, p < 0.001). No correlation was found between fear of falling and foot pain (r = 0.36; p = 0.11). Significant differences between cases and control participants were found between fear of falling (p = 0.001), foot impairment (p = 0.004) and foot disability (p < 0.001). Foot impairment and disability relates to fear of falling in women with established RA. A better understanding of fear of falling in people with established RA may contribute to more efficient falls assessments in order to identify at risk individuals.
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Affiliation(s)
- Tricia Morpeth
- Department of Podiatry, Health & Research Rehabilitation Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1020, New Zealand
| | - Angela Brenton-Rule
- Department of Podiatry, Health & Research Rehabilitation Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1020, New Zealand
| | - Matthew Carroll
- Department of Podiatry, Health & Research Rehabilitation Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1020, New Zealand
| | - Mike Frecklington
- Department of Podiatry, Health & Research Rehabilitation Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1020, New Zealand
| | - Keith Rome
- Department of Podiatry, Health & Research Rehabilitation Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1020, New Zealand.
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Ochi K, Furuya T, Ikari K, Taniguchi A, Yamanaka H, Momohara S. Association between serum vitamin D level and history of falls in elderly Japanese patients with rheumatoid arthritis. Mod Rheumatol 2015; 26:460-2. [DOI: 10.3109/14397595.2015.1085487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kensuke Ochi
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan and
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takefumi Furuya
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan and
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan and
| | - Atsuo Taniguchi
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan and
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan and
| | - Shigeki Momohara
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan and
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Ochi K, Furuya T, Ishibashi M, Watanabe M, Ikari K, Taniguchi A, Yamanaka H, Momohara S. Risk factors associated with the occurrence of proximal humerus fractures in patients with rheumatoid arthritis: a custom strategy for preventing proximal humerus fractures. Rheumatol Int 2015; 36:213-9. [DOI: 10.1007/s00296-015-3371-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/22/2015] [Indexed: 01/23/2023]
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Ochi K, Inoue E, Furuya T, Ikari K, Toyama Y, Taniguchi A, Yamanaka H, Momohara S. Ten-year incidences of self-reported non-vertebral fractures in Japanese patients with rheumatoid arthritis: discrepancy between disease activity control and the incidence of non-vertebral fracture. Osteoporos Int 2015; 26:961-8. [PMID: 25294026 DOI: 10.1007/s00198-014-2911-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 09/19/2014] [Indexed: 01/05/2023]
Abstract
UNLABELLED Despite improvements in rheumatoid arthritis disease activity of in the past 10 years, the incidence of self-reported non-vertebral fractures did not decrease in our cohort of 9,987 patients. This study may indicate that osteoporosis treatment and non-vertebral fracture prevention remain important regardless of the rheumatoid arthritis disease activity. INTRODUCTION Although rheumatoid arthritis (RA) is a risk factor for osteoporosis and fractures, few studies have described the association between disease activity and the fracture incidence in patients with RA. This study aimed to investigate changes in the non-vertebral fracture incidence between 2001 and 2010 in our Institute of Rheumatology Rheumatoid Arthritis (IORRA) cohort. METHODS The IORRA is a prospective observational cohort study of Japanese RA patients. A total of 9,987 patients with RA were enrolled in this cohort from 2000 to 2010. The clinical parameter and non-vertebral fracture occurrence data were collected biannually through self-reported questionnaires. Incidences of self-reported non-vertebral fractures were also analyzed via standardization according to gender, age, and disease activity during each 2-year period. RESULTS From 2001 to 2010, the percentage of patients with 28-joint disease activity score remission increased from 7.8 to 39.7%, prednisolone intake decreased from 51.4 to 41.3%, and bisphosphonate intake increased from 5.0 to 23.4%. The non-vertebral fracture incidence rates were 24.6/1,000 person-years in 2001 and 35.5/1,000 person-years in 2010, with no apparent change even after standardization. The overall non-vertebral fracture incidence was significantly higher in the autumn/winter than in the spring/summer (p = 0.02). CONCLUSION Despite improvements in disease activity and functional disability, the non-vertebral fracture incidence exhibited no apparent change between 2001 and 2010 in our patients with RA. Osteoporosis treatment and non-vertebral fracture prevention remain important regardless of the disease control in patients with RA.
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Affiliation(s)
- K Ochi
- Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan,
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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. Semin Arthritis Rheum 2015; 44:389-98. [DOI: 10.1016/j.semarthrit.2014.08.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 07/24/2014] [Accepted: 08/06/2014] [Indexed: 11/28/2022]
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Denkinger MD, Lukas A, Nikolaus T, Hauer K. Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: a systematic review. Am J Geriatr Psychiatry 2015; 23:72-86. [PMID: 24745560 DOI: 10.1016/j.jagp.2014.03.002] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 02/05/2014] [Accepted: 03/06/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fear of falling (FOF) is an important threat to autonomy. Current interventions to reduce FOF have yielded conflicting results. A possible reason for this discrepancy could be its multicausality. Some risk factors may not have been identified and addressed in recent studies. The last systematic review included studies until 2006. METHODS To identify additional risk factors for FOF and to test those mentioned previously, we conducted a systematic literature review. Studies examining FOF in community-dwelling older adults between 2006 and October 2013 were screened. RESULTS Outcomes are summarized with respect to different constructs such as FOF, fall-related self-efficacy/balance confidence, and FOF-related activity restriction. Odds ratios and p values are reported. There is no clear pattern with regard to the different FOF-related constructs studied. The only parameters robustly associated across all constructs were female gender, performance-based and questionnaire-based physical function, the use of a walking aid, and, less robust, a history of falls and poor self-rated health. Conflicting results were identified for depression and anxiety, multiple drugs, and psychotropic drugs. Other potentially modifiable risk factors were only mentioned in one or two studies and warrant further investigation. Parameters with mainly negative results are also presented. CONCLUSION Only few risk factors identified were robustly associated across all FOF-related constructs and should be included in future studies on FOF. Some newer factors have to be tested again in different cohorts. The comprehensive overview might assist in the conceptualization of future studies.
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Affiliation(s)
- Michael D Denkinger
- Agaplesion Bethesda Clinic, Geriatric Chair of Ulm University, Ulm, Germany.
| | - Albert Lukas
- Agaplesion Bethesda Clinic, Geriatric Chair of Ulm University, Ulm, Germany
| | - Thorsten Nikolaus
- Agaplesion Bethesda Clinic, Geriatric Chair of Ulm University, Ulm, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Clinic, Geriatric Centre of Heidelberg University, Heidelberg, Germany
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Yamagiwa K, Iijima S, Furuya T, Ikai T, Inoue E, Taniguchi A, Momohara S, Yamanaka H. Incidence of falls and fear of falling in Japanese patients with rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0351-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Koerich J, Armanini KK, Iop RDR, Borges Júnior NG, Domenech SC, Gevaerd MDS. Avaliação do equilíbrio corporal de pacientes com artrite reumatoide. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000400006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Controle postural, estabilidade nos movimentos voluntários, reação às perturbações externas e propriocepção constituem elementos básicos para a manutenção do equilíbrio. Pessoas com Artrite Reumatoide (AR) têm dificuldade em manter o controle postural, prejudicando o equilíbrio nas Atividades de Vida Diárias (AVD's), tornando-se um importante fator de risco para quedas. O presente estudo teve por objetivo avaliar o equilíbrio corporal de indivíduos com AR, em função do nível de atividade da doença. Foram avaliados 24 indivíduos com 54,66±9,52 anos. Todos foram submetidos à aplicação de questionário de identificação e história clínica, avaliações antropométricas, coleta de amostra sanguínea para análise de Proteína C-Reativa (PCR), determinação do nível de atividade da doença por meio do Disease Activity Score (DAS-28) e avaliação do equilíbrio através dos testes: Escala de Equilíbrio de Berg (EEB) e Timed Up and Go (TUG). Os pacientes foram divididos em três grupos: baixa, moderada e alta atividade da doença. Os resultados dos testes de equilíbrio demonstraram que, embora a amostra tenha apresentado baixo risco para quedas, o grupo em alta atividade da doença apresentou maior distribuição de frequência (57,2%) nos escores entre 48-52 na EEB, em comparação ao grupo moderada atividade, cuja distribuição de frequência predominou nos escores entre 53 e 56 (92,3%-p<0,05). Também foi verificada diferença no tempo de execução do TUG, entre os grupos alta (11,86±4,62s) e moderada (9,71±0,90s) atividade da doença (p<0,05). Estes dados evidenciam que o nível de atividade da doença pode influenciar na realização dos testes EEB e TUG, sugerindo um aumento do risco de quedas ou até mesmo uma dependência na realização de suas AVD's em função do aumento do nível de atividade da doença.
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Risk factors associated with the occurrence of distal radius fractures in Japanese patients with rheumatoid arthritis: a prospective observational cohort study. Clin Rheumatol 2013; 33:477-83. [DOI: 10.1007/s10067-013-2415-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/05/2013] [Accepted: 10/18/2013] [Indexed: 11/25/2022]
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Stanmore EK, Oldham J, Skelton DA, O'Neill T, Pilling M, Campbell AJ, Todd C. Risk factors for falls in adults with rheumatoid arthritis: a prospective study. Arthritis Care Res (Hoboken) 2013; 65:1251-8. [PMID: 23436687 PMCID: PMC3881513 DOI: 10.1002/acr.21987] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 02/13/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the association between potential risk factors and falls in community-dwelling adults with rheumatoid arthritis (RA). METHODS We followed patients for 1 year of followup in a prospective cohort study with monthly falls calendars and telephone calls. Lower extremity muscle strength, postural stability, number of swollen and tender joints, functional status, history of falling, fear of falling, pain, fatigue, medication, and use of steroids were assessed as risk factors for falls. RESULTS A total of 386 women and 173 men with RA (n = 559) ages 18-88 years completed baseline assessments and 535 participants (96%) completed 1-year followup. Bivariate logistic regression showed that falls risk was not associated with age or sex. Multivariate logistic regression revealed that a history of multiple falls in the previous 12 months was the most significant predictive risk factor (odds ratio [OR] 5.3, 95% confidence interval [95% CI] 2.3-12.3). The most significant modifiable risk factors were swollen and tender lower extremity joints (OR 1.7, 95% CI 1.1-2.7), psychotropic medication (OR 1.8, 95% CI 1.1-3.1), and fatigue (OR 1.13, 95% CI 1.02-1.2). CONCLUSION Adults with RA are at high risk of falls. In clinical practice, high-risk fall patients with RA can be identified by asking whether patients have fallen in the past year. Important risk factors highlighted in this study include swollen and tender lower extremity joints, fatigue, and use of psychotropic medications.
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Affiliation(s)
- Emma K Stanmore
- University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.
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Furuya T, Inoue E, Hosoi T, Taniguchi A, Momohara S, Yamanaka H. Risk factors associated with the occurrence of hip fracture in Japanese patients with rheumatoid arthritis: a prospective observational cohort study. Osteoporos Int 2013; 24:1257-65. [PMID: 22801953 DOI: 10.1007/s00198-012-2080-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 07/02/2012] [Indexed: 12/17/2022]
Abstract
UNLABELLED Risk factors associated with the occurrence of hip fracture in Japanese patients with rheumatoid arthritis (RA) were evaluated in a prospective, observational cohort study. Physical disability, advanced age, history of total knee replacement (TKR), and low body mass index (BMI) appear to be associated with the occurrence of hip fracture. INTRODUCTION This study seeks to evaluate the association between potential risk factors and the occurrence of hip fractures in Japanese RA patients. METHODS A total of 9,720 patients (82.1% female; mean age, 55.7 years) with RA were enrolled in a prospective observational study from 2000 to 2010. Self-reported hip fractures were verified using patient medical records. Cox proportional hazards models were used to analyze independent contributions of various risk factors to hip fracture occurrence. RESULTS During a mean follow-up of 5.2 years, 152 patients reported 152 hip fractures. Among these patients, 97 hip fractures in 97 patients (15 males, 82 females) were verified with medical records. Japanese version of the Health Assessment Questionnaire (J-HAQ) disability score [per 1 score, hazard ratio (HR), 2.64; 95% confidence interval (CI), 1.94-3.58], age (per 10 years; HR, 1.53; 95% CI, 1.25-1.87), history of TKR (HR, 3.75; 95% CI, 1.57-8.96), and BMI (per 1 kg/m2, HR, 0.92; 95% CI, 0.86-0.99) were significantly associated with hip fractures. Among the scores on the eight domains of the J-HAQ, J-HAQ (arising) (HR, 1.74; 95% CI, 1.28-2.36) and J-HAQ (hygiene) (HR, 1.58; 95% CI, 1.11-2.24) were significantly correlated with the occurrence of hip fracture. CONCLUSIONS High J-HAQ disability score, advanced age, history of TKR, and low BMI appear to be associated with the occurrence of hip fractures in Japanese RA patients. Among the eight domains of the J-HAQ, arising and hygiene disabilities appear to be correlated with the occurrence of hip fractures in this patient population.
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Affiliation(s)
- T Furuya
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
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Sites, frequencies, and causes of self-reported fractures in 9,720 rheumatoid arthritis patients: a large prospective observational cohort study in Japan. Arch Osteoporos 2013; 8:130. [PMID: 23526031 DOI: 10.1007/s11657-013-0130-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 02/18/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED Sites, frequencies, and causes of self-reported fractures in Japanese patients with rheumatoid arthritis (RA) were evaluated in a prospective, observational cohort study. The incidence and cause of fracture differ by anatomical site, sex, and age. These differences may be considered in establishing custom strategies for preventing fractures in RA patients in the future. PURPOSE The literature contains limited data describing the details of fractures at different skeletal sites in patients with RA. METHODS We evaluated the details of fractures in Japanese RA patients on the basis of our Institute of Rheumatology Rheumatoid Arthritis cohort study in 9,720 RA patients (82 % women; mean age, 56 years) who were enrolled from 2000 to 2010. The details of fractures were obtained through biannual patient self-report questionnaires. RESULTS Over a mean duration of 5.2 years, 1,317 patients (13.5 %) reported 2,323 incident fractures comprising 563 (24.2 %) clinical vertebral fractures and 1,760 (75.8 %) nonvertebral fractures. Rib fractures were the most common fractures in men, followed by clinical vertebral and hip fractures; the most common fractures in women were clinical vertebral fractures, followed by rib, foot, and hip fractures. There was a significant difference between sexes in the rates of rib, clavicle, shoulder, and ankle fractures. Spontaneous event was the primary cause of clinical vertebral fracture (65.4 %), whereas falls were the primary cause of upper extremity (76.5 %) and lower extremity (57.8 %) fractures. Rates of clinical vertebral and hip fractures increased, while those of rib and foot fractures decreased with increasing age. Incidence of falls, as causes of nonvertebral fractures, also increased in older age groups. CONCLUSION Our results suggest that the causes of fractures may differ depending on anatomical site and that prevention of falls may be the most effective way to reduce upper and lower extremity fractures, especially in older patients with RA.
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Furuya T, Hosoi T, Tanaka E, Nakajima A, Taniguchi A, Momohara S, Yamanaka H. Prevalence of and factors associated with vitamin D deficiency in 4,793 Japanese patients with rheumatoid arthritis. Clin Rheumatol 2013; 32:1081-7. [PMID: 23423442 DOI: 10.1007/s10067-013-2216-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 02/01/2013] [Accepted: 02/07/2013] [Indexed: 01/18/2023]
Abstract
To determine the prevalence of vitamin D deficiency and associations with clinical characteristics in Japanese patients with rheumatoid arthritis (RA), serum 25(OH)D levels, laboratory data, and clinical data were obtained from 4,793 patients with RA (4,075 women, 718 men, mean age 59.7 years) who participated in the Institute of Rheumatology Rheumatoid Arthritis observational cohort study in April and May of 2011. Serum vitamin D levels were evaluated using a radioimmunoassay. We defined vitamin D deficiency as <20 ng/mL and severe deficiency as <10 ng/mL. Associations of vitamin D deficiency with patient characteristics were examined using multivariate logistic regression. Among all patients, the mean (SD) serum 25(OH)D level was 16.9 ng/mL (6.1), and the prevalence of vitamin D deficiency and severe deficiency were 71.8 and 11.5%, respectively. In multivariate analysis, female gender, younger age, high Japanese version of health assessment questionnaire (HAQ) disability score, low serum total protein levels, low serum total cholesterol levels, high serum alkaline phosphate (ALP) levels, and non-steroidal anti-inflammatory drug (NSAID) use were significantly associated with vitamin D deficiency (P < 0.01). Vitamin D deficiency appears to be common in Japanese patients with RA, as previously reported for patients of other ethnicities. Female gender, younger age, high HAQ disability score, low serum levels of total protein and total cholesterol, high serum ALP levels, and NSAID use appear to be associated with vitamin D deficiency in Japanese patients with RA.
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Affiliation(s)
- Takefumi Furuya
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku 162-0054, Tokyo, Japan.
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Böhler C, Radner H, Ernst M, Binder A, Stamm T, Aletaha D, Smolen JS, Köller M. Rheumatoid arthritis and falls: the influence of disease activity. Rheumatology (Oxford) 2012; 51:2051-7. [PMID: 22879462 DOI: 10.1093/rheumatology/kes198] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the correlation between disease activity of RA and the risk of falling. METHODS Seventy-eight patients were tested. Disease activity was measured with acute-phase reactants, autoantibodies, swollen and tender joint count (SJC28, TJC28), pain on a visual analogue scale (VAS pain), patient and evaluator global assessment of disease activity (PGA, EGA), HAQ disability index (HAQ-DI), 28-joint DAS (DAS-28) and the clinical and simple disease activity indexes (CDAI, SDAI). The risk of falling was evaluated by a fall assessment consisting of Tinetti test (TIT), timed get up and go test (TUG), chair-rising test (CRT), tandem walk and tandem stand test. RESULTS During the last 12 months, 26.9% of the participants reported a fall and 46.2% mentioned the fear of falling. The most evident link [Spearman's correlation (r(s))] with the results of the fall assessment was found in HAQ-DI (CRT: r(s) = 0.523, TUG: r(s) = 0.620, TIT: r(s) = -0.676), CDAI (CRT: r(s) = 0.460, TUG: r(s) = 0.504, TIT: r(s) = -0.472), VAS pain (CRT: r(s) = 0.441, TUG: r(s) = 0.616, TIT: r(s) = -0.548) PGA (CRT: r(s) = 0.473, TUG: r(s) = 0.577, TIT: r(s) = -0.520) and TJC (CRT: r(s) = 0.488, TUG: r(s) = 0.394, TIT: r(s) = -0.385). Patients with higher disease activity achieved poorer results in the fall assessment. CONCLUSION The strongest correlation with falls was evident for patient-reported outcomes. Pain seems to be the common ground of these parameters. At the same time, disease activity influences pain. The results suggest an increased attention towards the risk of falling with patients of higher levels of disease activity or pain, and physio- or ergotherapeutical interventions as needed.
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Affiliation(s)
- Christoph Böhler
- Department of Acute Geriatric Medicine, SMZ Sophienspital, Apollogasse 19, Vienna 1070, Austria
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Smulders E, van Lankveld W, Eggermont F, Duysens J, Weerdesteyn V. Step Performance in Persons With Rheumatoid Arthritis: A Case-Control Study. Arch Phys Med Rehabil 2011; 92:1669-74. [DOI: 10.1016/j.apmr.2011.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 03/11/2011] [Accepted: 04/14/2011] [Indexed: 11/29/2022]
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Yamanaka H. [108th Scientific Meeting of the Japanese Society of Internal medicine: invited lecture: 5. IORRA, a large cohort study for rheumatoid arthritis in Japan]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2011; 100:2447-2463. [PMID: 22117333 DOI: 10.2169/naika.100.2447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Japan
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Furuya T, Hosoi T, Saito S, Inoue E, Taniguchi A, Momohara S, Yamanaka H. Fracture risk assessment and osteoporosis treatment disparities in 3,970 Japanese patients with rheumatoid arthritis. Clin Rheumatol 2011; 30:1105-11. [DOI: 10.1007/s10067-011-1748-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 03/28/2011] [Accepted: 04/01/2011] [Indexed: 01/30/2023]
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Hayashibara M, Hagino H, Katagiri H, Okano T, Okada J, Teshima R. Incidence and risk factors of falling in ambulatory patients with rheumatoid arthritis: a prospective 1-year study. Osteoporos Int 2010; 21:1825-33. [PMID: 20119662 DOI: 10.1007/s00198-009-1150-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 11/12/2009] [Indexed: 11/26/2022]
Abstract
UNLABELLED A prospective 1-year study showed that fall incidence was 50% in women with rheumatoid arthritis. Multivariate analysis identified swollen joint count, use of antihypertensives or diuretics, one-leg standing time, and sway area measured by stabilometer as significant parameters associated with falls. INTRODUCTION Patients with rheumatoid arthritis (RA) may be at increased risk of falling because they frequently experience muscle weakness and stiff or painful joints. The aim of this study was to use a prospective design to determine the incidence of falls and their risk factors in women with RA. METHODS Eighty-four women aged 50 and over who had RA were enrolled. The mean age was 64.1 years. We evaluated postural stability, physical performance related to falls, disease activity, muscle volume, and bone density. The occurrence of falls was assessed every month for 1 year. Among 84 patients, 80 completed a 1-year observation. RESULTS Forty patients (50.0%) reported one or more falls, and two of them (5.0%) had fractures during the follow-up period. The fall group had more swollen joints and took more antihypertensives and/or diuretics. The fall group also had lower postural stability and tended to have reduced physical performance. The one-leg standing time was shorter, and the step-up-and-down test score was lower in the fall group. The sway area was larger in the fall group. DISCUSSION Multiple logistic regression analysis identified that number of swollen joints, use of antihypertensives or diuretics, shorter time standing on one foot, and the sway area were the most significant parameters associated with falls. CONCLUSION We concluded that fall rates in RA patients were higher than in the general population and that balance impairment or side effects of drugs may play a role in increasing the risk of falls.
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Affiliation(s)
- M Hayashibara
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan.
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Yamagiwa K, Iijima S, Furuya T, Ikai T, Inoue E, Taniguchi A, Momohara S, Yamanaka H. Incidence of falls and fear of falling in Japanese patients with rheumatoid arthritis. Mod Rheumatol 2010; 21:51-6. [PMID: 20842405 DOI: 10.1007/s10165-010-0351-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 08/11/2010] [Indexed: 10/19/2022]
Abstract
The objective of this study is to determine the incidence of falls and fear of falling by gender and age in Japanese patients with rheumatoid arthritis (RA). Among the Japanese patients who participated in a single-institute-based prospective observational cohort study of patients with RA, namely the Institute of Rheumatology Rheumatoid Arthritis, 765 men (median age 63 years) and 4,231 women (median age 60 years) with RA responded to questions related to falls. Eight percent of men and 11% of women reported one or more falls during the previous 6 months. At least one fall and multiple falls were significantly more frequent in men (p < 0.05) and in women (p < 0.001) with RA over age 65 and age 75 years, respectively, although there was no significant linear increase in risk with age. Sixteen percent of men and 22% of women reported fear of falling. More men over age 65 tended to report fear of falling than those under age 65 (p < 0.001), although the incidence of women with fear of falling increased with advancing age. Japanese patients with RA over age 65 and age 75 appeared to have a high risk of at least one fall and multiple falls, respectively.
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Affiliation(s)
- Kiyotaka Yamagiwa
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjyuku-ku, Tokyo, 162-0054, Japan
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