From health.yahoo.com
By Sarah Bence
Rheumatoid arthritis (RA) can increase your chances of falling, with some research showing that up to 54 percent of people with RA experience a fall during a given year. And the more active your RA is, the higher your risk. Falls aren't something to brush off. A simple trip over a rug or slip while walking the dog can have major consequences.
Falls can cause serious injury, including hip fracture, and lead to an increased fear of falling. If someone's afraid of falling they might restrict their activity, which can further weaken muscles and raise fall risk over time.
So, what causes this increased fall risk in RA, and what can you do to lower your personal risk?
Causes of Falls in Rheumatoid Arthritis
RA can affect someone's fall risk in several ways.
Swollen or deformed lower body joints can make walking difficult
Swollen or deformed upper body joints make catching yourself difficult
Decreased muscle strength can affect balance
Changes in gait (walking pattern) may lead to a fall
Fatigue can make you more prone to fall
Dizziness, which can be a side effect of certain medications or related to RA complications, can affect balance
"Falling, for all adults, is multifactorial," says Thomas Atwood, a physical therapist and fall prevention specialist in Hebron, Connecticut. Any of the factors above - plus others like older age, footwear that doesn't have enough traction, or an environment such as a slippery floor or uneven ground - can combine to cause falls.
Just because you have RA doesn't mean you're automatically at a high fall risk, however. Some research shows that people with RA who fell in the previous year were more likely to:
Be older
Have greater disease severity
Experience dizziness more frequently
Take psychotropic medications (drugs that influence brain chemicals, affecting emotions and behaviour)
How Do Doctors Assess Fall Risk?
"There is not a widely adopted fall risk assessment that's specifically designed for people with rheumatoid arthritis," says Julia Loewenthal, MD, a geriatrician in the Boston area and an assistant professor at Harvard Medical School. "But we need to recognize the impact that tender joints and fatigue have on one's risk of falls."
To assess your fall risk, your doctor may use general fall screening tools, and will also consider individual risk factors related to your RA.
"Unfortunately, the more common approach is reactive," says Dr. Loewenthal, referring to doctors treating someone after they've fallen, rather than working to prevent the initial fall. According to Loewenthal, a more proactive approach would include:
Asking if you have experienced any symptoms that increase fall risk (such as dizziness, vision changes, muscle weakness, joint swelling, or fatigue)
Examining your gait and balance
Reviewing which RA medications you take (as some may cause side effects like dizziness that increase fall risk)
How Do Rehab Professionals Assess Fall Risk?
If you're referred to a physical therapist (PT) or occupational therapist (OT), they will also evaluate your fall risk.
This usually includes screening tests. One example is the Timed Up and Go (TUG) test, which asks you to stand from a chair, walk 10 feet, and return to the chair. Taking 12 seconds or longer is considered the cut-off for fall risk.
Your therapist may also ask you to walk around and perform tasks. They'll be looking at things like your step length, weight bearing, postural stability, and other movement patterns.
PTs and OTs also may evaluate your home environment and activities for things that increase fall risk. For instance, if you struggle to lift your swollen knee over the rim of your tub, you're raising your fall risk, particularly if the tub floor is slippery. That's an example of how RA and environmental factors (like having a tub vs. a walk-in shower) combine to increase fall risk.
Working With Your Doctor to Reduce Your Fall Risk
Your doctor may recommend several things if they believe you're at a heightened risk of falls.
"Reviewing medications is an important step I think most healthcare providers would take," says Loewenthal. Evidence shows that taking opioids or antidepressants increases fall risk, and research on people with RA also shows that psychotropic medications are associated with falls.
It's possible that your medications may need to be adjusted to lower your risk of falls, while still keeping your RA symptoms in check.
Your doctor may also screen for osteopenia (low bone density) and osteoporosis (advanced bone loss), which can put you at a greater risk of fractures after a fall. "Patients with RA are often at higher risk of these conditions due to the disease and courses of steroids," says Loewenthal.
Finally, your doctor may make referrals to specialists in fall prevention (physical therapy or occupational therapy), or a rheumatologist if you're not already seeing one.
Work With Your Physical Therapist or Occupational Therapist to Reduce Fall Risk
Here are some ways that physical and occupational therapists help reduce falls.
Mobility Aids Your therapist may recommend mobility aids, such as a cane or rolling walker, to normalize your stride length and improve balance. Therapy will also involve training in how to safely use these devices.
Heat or Cold For pain management, ice can reduce swelling and heat can increase blood flow, relax muscles, and relieve joint pain.
TENS If there are no contraindications, transcutaneous electrical nerve stimulation can help improve blood flow and decrease pain, according to Atwood.
Therapeutic Exercise Your therapist may prescribe a personalized exercise program to increase muscle activation and functional strength and improve your overall joint and functional mobility and balance.
Dynamic Weight Shifting Practicing weight shifting during movement, especially while turning, is a crucial skill for controlling balance.
Education Learning why RA flare-ups occur may help you manage and reduce them.
Home Safety If you're seeing an at-home OT or PT, they may advise you on ways to adjust your environment to reduce fall risk and make tasks easier. This might include having grab bars installed, using a shower transfer bench, adding a nonslip bath mat, removing rugs, adding stair treads, and more.
Energy Conservation Your therapist may advise on ways to conserve your energy, for example breaking up tasks or practicing breathing techniques.
What You Can Do on Your Own to Reduce Fall Risk
"You don't have to wait until you're 'high risk' to enact lifestyle changes that help with fall prevention," says Loewenthal. There are meaningful steps you can take, today, to reduce your own fall risk.
Loewenthal recommends cultivating a yoga practice or strength training, regardless of your age, to improve balance and strength.
Supporting your mental health is equally important. "One of the most common [causes of] increases in fall risk with RA is the impact of depression and emotional coping with the disease," says Atwood. If you're feeling depressed or anxious about having RA, you might consider talking to a therapist, attending a support group, or making time for an activity you love.
Managing your body weight can also help prevent falls. "More weight carried through joints increases pain and changes postural integrity," says Atwood. Eating a healthy, balanced diet (for example, the Mediterranean diet) and exercising regularly can help support your weight.
The Takeaway
People with rheumatoid arthritis have an increased risk of falling, particularly when the disease is more active.
Work with your doctor to review medications that may increase your fall risk, get screened for bone density issues, and consider physical or occupational therapy.
Exercise like yoga or strength training can improve balance, while making home safety modifications and taking care of your mental health can reduce fall risk.
