Rheumatoid arthritis (RA) significantly increases the risk of falls in elderly patients through a combination of physical, neurological, and systemic factors that impair balance, strength, and mobility. RA is a chronic autoimmune disease that causes inflammation primarily in the joints, leading to pain, swelling, stiffness, and progressive joint damage. In older adults, these symptoms are often more severe and compounded by age-related changes, making falls more likely.
One of the main ways RA raises fall risk is through **joint damage and deformity**. The inflammation in RA attacks the synovial lining of joints, causing erosion of cartilage and bone. This leads to joint instability, deformities, and reduced range of motion, especially in weight-bearing joints like the knees, hips, and ankles, as well as in the wrists and hands. When joints are unstable or painful, elderly patients may alter their gait or posture to compensate, which disrupts normal balance and coordination. For example, swollen or deformed feet and ankles can cause uneven weight distribution and increase the chance of tripping or slipping.
**Muscle weakness and loss of physical function** are also critical contributors. Chronic inflammation in RA can cause muscle wasting (sarcopenia), and pain often leads to reduced physical activity. Over time, this results in diminished muscle strength and endurance, which are essential for maintaining balance and recovering from a stumble. Elderly patients with RA frequently experience fatigue and functional impairment, which further limit their ability to perform daily activities safely. The combination of weak muscles and joint pain creates a vicious cycle where fear of falling leads to less movement, which then worsens weakness and balance problems.
**Pain and stiffness** from RA flare-ups can severely restrict mobility. Morning stiffness and joint pain reduce the ability to move freely and quickly, impairing reflexes needed to prevent a fall. Stiff joints also affect proprioception—the body’s sense of position and movement—which is vital for balance. When proprioception is impaired, patients may not accurately sense their body’s position relative to the ground, increasing instability.
Neurological factors linked to RA can also play a role. Some patients develop **peripheral neuropathy** or nerve compression syndromes (such as carpal tunnel syndrome), which reduce sensation in the feet and hands. Loss of sensation impairs the ability to detect uneven surfaces or obstacles, making falls more likely. Cognitive impairment and depression, which are more common in elderly RA patients, can further reduce attention and reaction times, increasing fall risk.
Nutritional status is another important but often overlooked factor. Elderly RA patients may suffer from **undernutrition or malnutrition**, which exacerbates muscle loss and weakness. Poor nutrition reduces energy levels and the body’s ability to repair tissues, contributing to frailty and vulnerability to falls.
Medications used to treat RA can also influence fall risk. Some drugs, like corticosteroids, can cause osteoporosis, increasing the risk of fractures if a fall occurs. Others may cause dizziness or low blood pressure, which can precipitate falls.
Environmental and lifestyle factors compound these risks. Elderly RA patients who are less physically active due to pain or fear of falling may lose balance and coordination skills. Lack of regular exercise reduces muscle strength and joint flexibility, both crucial for fall prevention. Additionally, RA often affects the feet and gait, and without proper footwear or orthotic support, patients may have unstable footing.
In summary, rheumatoid arthritis increases fall risk in elderly patients through a complex interplay of joint damage, muscle weakness, pain, neurological impairments, nutritional deficits, medication side effects, and reduced physical activity. These factors collectively impair balance, mobility, and the ability to respond to sudden loss of stability, making falls a common and serious concern in this population. Addressing these issues through comprehensive management—including medication, physiotherapy, exercise, nutritional support, and environmental modifications—is essential to reduce fall risk and maintain independence in elderly patients with RA.
