Evaluation of peripheral neuropathy in lower limbs of patients with rheumatoid arthritis and its relation to fall risk

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.

Relationship between the Risk of Falling and Physical Function in Elderly Individuals with Lower Extremity Arthritis

“…A significant majority, 70% (105 individuals), reported experiencing considerable difficulty in performing daily activities, highlighting the debilitating impact of lower extremity arthritis on their functional capacity. Moreover, an overwhelming 80% (120 individuals) of the study cohort expressed a fear of falling, a concern that significantly outweighs the 20% (30 individuals) who did not share this fear (16,21). These findings align with existing literature that underscores the intricate relationship between arthritis in the lower extremities and an increased risk of falls among the elderly.…”

“…Given the high prevalence of lower limb arthritis among the elderly and its direct correlation with discomfort, reduced functionality, and disability, a thorough understanding of its impact on physical function and fall risk is indispensable (5,6). This knowledge is pivotal in devising targeted interventions aimed at mitigating these risks and enhancing the quality of life for this vulnerable population segment (10,16).…”

Racial Differences in Multimorbidity and Comorbidities in Rheumatoid Arthritis

“…Indeed, other large studies of cancer overall have also shown no increased (20,43,44) or net decreased risk of cancer (45). Finally, the presence of an association between several comorbidities and RA in this study served as a reassuring positive control given established connections from RA literature including asthma (46), COPD (47), CAD (48), GERD and thyroid disease (20), ILD (49), obesity (18), and neuropathy, including vasculitic neuropathy (50), peripheral neuropathy (51), and carpal tunnel syndrome (52).…”

Effect of Combined Neuromuscular Electrical Stimulation and Disease-Modifying Antirheumatic Drug Therapy Versus Disease-Modifying Antirheumatic Drug Therapy Alone on Enhancing Gait and Reducing Fall Risks in Patients with Rheumatoid Arthritis and Peripheral Neuropathy

“…The existing literature underscores the importance of comprehensive treatment approaches in RA, emphasizing the need for interventions that not only control disease activity but also address functional impairments and quality of life. However, there is a gap in understanding how combined therapeutic modalities can optimize these outcomes, particularly in the context of RA with concurrent PN (10)(11)(12). This research aims to fill the identified gap by comparing the effectiveness of combined NMES and DMARD therapy versus DMARD therapy alone in enhancing gait and reducing fall risks in RA patients with PN.…”