From the Guidelines
Managing recurrent falls in patients with rheumatoid arthritis requires a comprehensive approach that includes exercise, rehabilitation, and lifestyle modifications to address multiple risk factors and improve overall quality of life. The most recent and highest quality study, the 2022 American College of Rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis 1, emphasizes the importance of a multidisciplinary approach to managing RA, including the use of exercise, physical therapy, and occupational therapy to improve physical function and reduce the risk of falls.
Key components of a fall prevention program for patients with RA include:
- A thorough fall risk assessment to evaluate gait, balance, muscle strength, joint function, and medication side effects
- Physical therapy to improve strength, balance, and coordination through targeted exercises, with particular attention to lower extremity joints affected by RA
- Occupational therapy to help with home modifications, such as installing grab bars, removing trip hazards, and improving lighting
- Medication management to review and potentially adjust medications that may contribute to falls, including sedatives, antidepressants, and some pain medications
- Use of assistive devices, such as canes, walkers, or proper footwear with good support, to provide stability
- Regular vision and hearing assessments to identify and address sensory deficits that may contribute to falls
- Patient education about fall prevention strategies and the importance of reporting falls to healthcare providers
The guideline conditionally recommends consistent engagement in exercise, including aerobic, resistance, aquatic, and mind-body exercise, to improve physical function and reduce the risk of falls 1. It also recommends the use of joint protection techniques, activity pacing, energy conservation, and fatigue management to preserve physical function and manage fatigue 1. Additionally, the guideline suggests the use of assistive devices, adaptive equipment, and environmental adaptations to improve function and quality of life, and to reduce the risk of falls.
Overall, a comprehensive approach that addresses the complex factors contributing to falls in RA patients, including joint damage, muscle weakness, pain, medication effects, and balance impairments, is essential to improving outcomes and reducing the risk of recurrent falls. By prioritizing exercise, rehabilitation, and lifestyle modifications, healthcare providers can help patients with RA to improve their overall quality of life and reduce their risk of falls.
From the Research
Managing Recurrent Falls in Rheumatoid Arthritis (RA) Patients
To manage recurrent falls in patients with rheumatoid arthritis (RA), it is essential to understand the risk factors associated with falls in this population.
- Fall-related risk factors are common in women with RA, including abnormal heel-toe walking and inability to perform standups 2.
- The incidence of falls in women with RA is approximately 50% over a one-year period, with swollen joint count, use of antihypertensives or diuretics, one-leg standing time, and sway area measured by stabilometer being significant parameters associated with falls 3.
- A history of multiple falls in the previous 12 months is the most significant predictive risk factor for falls in adults with RA, along with swollen and tender lower extremity joints, psychotropic medication, and fatigue 4.
Strategies for Managing Recurrent Falls
Several strategies can be employed to manage recurrent falls in RA patients, including:
- Assessing and addressing modifiable risk factors such as swollen and tender lower extremity joints, fatigue, and use of psychotropic medications 4.
- Evaluating the effects of disease activity and bone-influencing medications such as glucocorticoids on osteoporosis and fracture risk 5.
- Using disease-modifying antirheumatic drugs to control disease activity and hamper generalized bone loss 5.
- Providing calcium supplementation and sufficient vitamin D use, particularly in glucocorticoid users 5.
- Considering anti-osteoporotic medications such as oral bisphosphonates, parenteral antiresorptives, and anabolic agents 5.
Importance of Multidisciplinary Approach
A multidisciplinary approach is crucial in managing recurrent falls in RA patients, involving healthcare professionals from rheumatology, orthopedics, physical therapy, and other relevant specialties.