690 The Journal of Rheumatology 2006; 33:4 Prevalence and Associated Factors for Falls in Women with Established Inflammatory Polyarthritis ANNAE. OSWALD, STEPHEN R. PYE, TERENCE W. O’NEILL, DIANE BUNN, KARL GAFFNEY, TARNYAMARSHALL, ALAN J. SILMAN, and DEBORAH P.M. SYMMONS ABSTRACT. Objective. To determine the one-year period prevalence and factors associated with falls in a commu- nity based cohort of women with established inflammatory polyarthritis (IP). Methods. The Norfolk Arthritis Register is a primary-care based inception cohort of subjects with IP aged 16 years and over. At the 10-year visit, subjects completed the Health Assessment Questionnaire (HAQ) and were examined for both active and inactive joint involvement. A subset of subjects was invited to complete a questionnaire about falls in the previous 12 months and questions about putative risk factors for falls. Logistic regression was used to determine whether there was any association between falls in the previous year and both putative disease and non-disease related risk factors. Results. Of the 316 women (mean age 59 yrs) who completed the falls questionnaire, 34% reported a fall in the previous year. Falls were more frequent in those over age 75 years, although there was no significant linear increase in risk with age. Swollen joint count [per 10 joints, odds ratio (OR) 1.7; 95% confidence interval (CI) 1.0, 2.8] and increasing visual analog scale pain score (per 10 mm, OR 1.1; 95% CI 1.0, 1.2) were associated with an increased risk of falls. Those who fell had higher overall HAQ scores (OR 1.7; 95% CI 1.3, 2.3) as well as higher scores for all of the individual domains of the HAQ (OR 1.7 to 2.2). Similarly, low levels of outdoor physical activity (OR 3.3; 95% CI 1.7, 6.5), impaired vision (OR 2.7; 95% CI 1.2, 6.3), and impaired general health (OR 2.9; 95% CI 1.7, 4.8) were associ- ated with an increased risk of falls. In a multivariate model, HAQ score, low levels of physical activi- ty, impaired vision, and impaired general health were independently linked with falls. Sixty-one percent of subjects with 3 of these risk factors had reported a fall in the previous year. Conclusion. In this inception cohort of women with longstanding IP, one in 3 reported falling in the previous year. Using a simple measure, a group that had particularly high risk can be identified. (First Release Feb 15, 2006; J Rheumatol 2006;33:690–4) Key Indexing Terms: FALLS INFLAMMATORY POLYARTHRITIS EPIDEMIOLOGY RISK FACTORS From the ARC Epidemiology Unit, The University of Manchester, Manchester, UK; Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada; and Department of Rheumatology, Norfolk and Norwich University Hospitals Trust, Norwich, UK. Supported by the Arthritis Research Campaign. A.E. Oswald, MD, FRCPC, Clinical Research Fellow, University of Manchester and University of Alberta; S.R. Pye, BSc(Hons), Research Assistant; T.W. O’Neill, MD, FRCP, Senior Lecturer in Rheumatic Disease Epidemiology, University of Manchester; D. Bunn, BSc(Hons), MSc, RGN, Clinical Manager; K. Gaffney, MB, BCh, BAO, FRCP, Consultant Rheumatologist; T. Marshall, MBBS, MRCP, Norfolk and Norwich University Hospitals Trust; A.J. Silman, MD, FRCP, Professor in Rheumatic Disease Epidemiology; D.P.M. Symmons, MD, FRCP, Professor in Rheumatology and Musculoskeletal Epidemiology, The University of Manchester. Address reprint requests to Dr. T.W. O’Neill, ARC Epidemiology Unit, The University of Manchester, Oxford Road, Manchester, M13 9PT, United Kingdom. E-mail: Terry@fs1.ser.man.ac.uk Accepted for publication November 25, 2005. Rheumatoid arthritis (RA) is a serious and debilitating form of arthritis affecting about 1% of the adult population 1 . Complications related to RA include an increased risk of hip fracture 2-4 . In part this may be a consequence of reduced bone mass in patients with the disease 5-9 . Other factors that influ- ence bone strength such as bone quality may also be impor- tant 10 . Fractures, however, occur as a result of an interaction between increased bone fragility and trauma typically due to falls. Data from clinic based studies suggest that about one in 3 adults with RA fall each year 11-13 . The fall risk in RA may be in part related to the joint abnormalities, muscle wasting, and functional impairment linked with the disease. To date, there are few studies that have looked at risk fac- tors for falling in subjects with inflammatory arthritis includ- ing assessment of joint counts and functional ability. In a recent clinic based study we showed that lower limb disabili- ty was a risk factor for falls in RA 13 . In a survey of 128 women with RA in the United States, there was no association between falls, pain intensity, or total joint count 12 . Knowledge of risk factors for falls is potentially important — identifica- tion of individuals at high risk may help target prevention measures such as exercise programs or assistive devices. The aims of our study were to determine the one-year period prevalence of falls and to identify the contribution of both arthritis related and other host factors that are associat- ed with falls in women with established inflammatory poly- arthritis (IP). Personal non-commercial use only. The Journal of Rheumatology Copyright © 2006. All rights reserved. www.jrheum.org Downloaded on April 30, 2021 from