Psoriatic arthritis

Foot problems in PsA linked to falls

About half (49%) of patients with psoriatic arthritis (PsA) report a history of falls in the preceding 12 months, according to an online survey of more than 600 Australian patients.

The survey, published in a letter to the editor in Rheumatology, also found that more than 30% of those patients reported their falls as recurrent.

“Whilst previous studies have investigated the contribution of foot-related impairments to greater falls risk in RA and older adults, there is limited falls research in PsA, and the younger age of this PsA cohort should be noted,” the investigators said in their letter.

“Distinct gait impairments have previously been demonstrated in those with PsA-related rearfoot enthesial pain, and indeed patient-reported problems in the rearfoot were a common finding in those who report falls (n=197, 74%).”

Survey respondents had a median age of 51 years and duration of disease of 8.5 years.

The majority of fallers reported they did not participate in the recommended weekly amount of moderate or vigorous physical exercise.

The investigators, led by podiatrist Kate Carter from Western Sydney University, said shifts in the centre of mass associated with spondyloarthropathies may potentially increase instability.

And reduced spinal mobility may limit the available strategies with which to compensate, further increasing the risk of falls.

“Muscle atrophy and weakness related to sarcopenia, cachexia and sarcopenic obesity may be important contributory factors to falls, but there is a paucity of research on muscle mass, morphology, strength and functional performance in those with PsA.”

They said about 40% of the respondents reported having depression or anxiety and that comorbid conditions and psychotropic medication use was also a significant risk factor for falls.

“The cross-sectional design of this study prohibits any determination of causality, but these preliminary results provide an important initial insight that may help to inform future studies.”

“With falls being associated with a significant burden of morbidity, mortality and healthcare cost, future prospective research should be directed towards the identification of potential risk factors for falls in those with PsA and the subsequent development of targeted interventions.”

Earlier qualitative research by the same team found patients with PsA-related foot and ankle problems commonly report “persistent” or “unpredictable” foot pain that was exacerbated by walking.

Foot pain and stiffness contributed to functional limitations, a change in gait which included descriptions of feeling unstable, and pain avoidance behaviour.

Participants reported foot-related disability impacted all areas of their lives including daily activity, social participation, family and work life.

“In routine health care consultations, people with PsA may not have the opportunity to describe in-depth the impact of foot problems on their lives. As a result, the burden may not be properly appreciated by health professionals,” the study said.

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