Evaluation of Peripheral Neuropathy in Lower Limbs of Patients with Rheumatoid Arthritis and Its Relation to Fall Risk

Overview

Journal Adv Rheumatol

Publisher Biomed Central

Specialty Rheumatology

Date 2022 Mar 23

PMID 35317839

Authors

Fabio de Araujo Pereira

Mariana de Almeida Lourenco

Marcos Renato de Assis

Affiliations

Soon will be listed here.

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.

Citing Articles

Racial Differences in Multimorbidity and Comorbidities in Rheumatoid Arthritis.

Kronzer V, Dykhoff H, Stevens M, Myasoedova E, Davis 3rd J, Crowson C Arthritis Care Res (Hoboken). 2022; 75(1):76-84.

PMID: 36094853 PMC: 9797440. DOI: 10.1002/acr.25020.

References

Khow K, Visvanathan R . Falls in the Aging Population. Clin Geriatr Med. 2017; 33(3):357-368. DOI: 10.1016/j.cger.2017.03.002. View

Furuya T, Yamagiwa K, Ikai T, Inoue E, Taniguchi A, Momohara S . Associated factors for falls and fear of falling in Japanese patients with rheumatoid arthritis. Clin Rheumatol. 2009; 28(11):1325-30. DOI: 10.1007/s10067-009-1229-5. View

Bugdayci D, Paker N, Rezvani A, Kesiktas N, Yilmaz O, Sahin M . Frequency and predictors for falls in the ambulatory patients with rheumatoid arthritis: a longitudinal prospective study. Rheumatol Int. 2013; 33(10):2523-7. DOI: 10.1007/s00296-013-2757-5. View

Lanzillo B, Pappone N, Crisci C, di Girolamo C, MASSINI R, Caruso G . Subclinical peripheral nerve involvement in patients with rheumatoid arthritis. Arthritis Rheum. 1998; 41(7):1196-202. DOI: 10.1002/1529-0131(199807)41:7<1196::AID-ART8>3.0.CO;2-R. View

Smolen J, Aletaha D, McInnes I . Rheumatoid arthritis. Lancet. 2016; 388(10055):2023-2038. DOI: 10.1016/S0140-6736(16)30173-8. View

Richardson J, Hurvitz E . Peripheral neuropathy: a true risk factor for falls. J Gerontol A Biol Sci Med Sci. 1995; 50(4):M211-5. DOI: 10.1093/gerona/50a.4.m211. View

Rome K, DIXON J, Gray M, Woodley R . Evaluation of static and dynamic postural stability in established rheumatoid arthritis: exploratory study. Clin Biomech (Bristol). 2009; 24(6):524-6. DOI: 10.1016/j.clinbiomech.2009.03.005. View

Kawabata K, Matsumoto T, Kasai T, Chang S, Hirose J, Tanaka S . Association between fall history and performance-based physical function and postural sway in patients with rheumatoid arthritis. Mod Rheumatol. 2020; 31(2):373-379. DOI: 10.1080/14397595.2020.1731134. View

Aydog E, Bal A, Aydog S, Cakci A . Evaluation of dynamic postural balance using the Biodex Stability System in rheumatoid arthritis patients. Clin Rheumatol. 2005; 25(4):462-7. DOI: 10.1007/s10067-005-0074-4. View

10.

Marques W, Cruz V, Rego J, da Silva N . [The influence of physical function on the risk of falls among adults with rheumatoid arthritis]. Rev Bras Reumatol. 2015; 54(5):404-8. DOI: 10.1016/j.rbr.2014.03.019. View

11.

Karaca Umay E, Gurcay E, Bora Karsli P, Cakci A . Sensory disturbance and polyneuropathy in rheumatoid arthritis patients with foot deformity. Rev Bras Reumatol Engl Ed. 2016; 56(3):191-7. DOI: 10.1016/j.rbre.2015.08.010. View

12.

Oytun Bayrak A, Durmus D, Durmaz Y, Demir I, Canturk F, Onar M . Electrophysiological assessment of polyneuropathic involvement in rheumatoid arthritis: relationships among demographic, clinical and laboratory findings. Neurol Res. 2010; 32(7):711-4. DOI: 10.1179/016164109X12581096870195. View

13.

van der Woude D, van der Helm-van Mil A . Update on the epidemiology, risk factors, and disease outcomes of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2018; 32(2):174-187. DOI: 10.1016/j.berh.2018.10.005. View

14.

Mills P, Barrett R, Morrison S . Toe clearance variability during walking in young and elderly men. Gait Posture. 2007; 28(1):101-7. DOI: 10.1016/j.gaitpost.2007.10.006. View

15.

Hart F, GOLDING J, MACKENZIE D . Neuropathy in rheumatoid disease. Ann Rheum Dis. 1957; 16(4):471-80. PMC: 1006992. DOI: 10.1136/ard.16.4.471. View

16.

Stanmore E, Oldham J, Skelton D, ONeill T, Pilling M, Campbell A . Fall incidence and outcomes of falls in a prospective study of adults with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012; 65(5):737-44. PMC: 4471630. DOI: 10.1002/acr.21892. View

17.

Biswas M, Chatterjee A, Ghosh S, Dasgupta S, Ghosh K, Ganguly P . Prevalence, types, clinical associations, and determinants of peripheral neuropathy in rheumatoid patients. Ann Indian Acad Neurol. 2011; 14(3):194-7. PMC: 3200043. DOI: 10.4103/0972-2327.85893. View

18.

Martyn C, Hughes R . Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1997; 62(4):310-8. PMC: 1074084. DOI: 10.1136/jnnp.62.4.310. View

19.

Bouche P, Cattelin F, Saint-Jean O, Leger J, Queslati S, Guez D . Clinical and electrophysiological study of the peripheral nervous system in the elderly. J Neurol. 1993; 240(5):263-8. DOI: 10.1007/BF00838158. View

20.

Armstrong C, Swarbrick C, Pye S, ONeill T . Occurrence and risk factors for falls in rheumatoid arthritis. Ann Rheum Dis. 2005; 64(11):1602-4. PMC: 1755283. DOI: 10.1136/ard.2004.031195. View