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Aktuelle Rheumatologie 2021; 46(04): 406-415
DOI: 10.1055/a-1353-4415
Original Article

Falls in Rheumatoid Patients: Does Ankle and Foot Ultrasonography have a Predictive Role? A Single-blind Study

Stürze bei Patienten mit rheumatoider Arthritis: Hat die Sonographie am Knöchel und Fuß einen Vorhersagewert? Eine Einfachblindstudie
Eman A.M. Alkady
1   Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University Faculty of Medicine, Assiut, Egypt
,
Marwa Mahmoud Abdelaziz
2   Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University Faculty of Medicine, Assiut, Egypt
,
Dalia Abdelwahed
1   Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University Faculty of Medicine, Assiut, Egypt
,
Safaa A. Mahran
1   Department of Rheumatology, Rehabilitation and Physical Medicine, Assiut University Faculty of Medicine, Assiut, Egypt
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ABSTRACT

Background Rheumatoid arthritis (RA) patients have a higher prevalence of falls compared with the healthy population. Several risk factors of falls in RA have been postulated, including high disease activity, low balance, muscle weakness and non-treatment with biologics.

Aim of the work We investigated our hypothesis that the sonographically detected ankle and foot changes in RA patients can predict falls in this population. To our knowledge, no previous study had investigated this before.

Methods In a total of 101 RA patients, we performed assessments of disease activity, disability level, gait speed, balance status, clinical examination of ankle and foot and an MSUS assessment of the ankle and foot joints and tendons as possible risk factors of falls.

Results The Berg balance test had the highest fall-predicting power (71.3%), followed by a gait speed test and restricted range of motion (ROM) of the Rt. subtalar joint, each with a predictive power of 70.3%. Of the sonographic findings, erosion of the first metatarsophalangeal (MTP) joint was the most accurate fall predictor, followed by erosion of the talonavicular joint and tenosynovitis of the ankle dorsal flexors with an area under the curve of 0.656, 0.642 and 0.614, respectively.

Conclusion The use of the MSUS as an adjunct objective method for predicting falls in RA patients has not been studied before. It was found that clinical foot and balance testing was a superior and easier way of predicting falls in RA patients than using ultrasonography.

ZUSAMMENFASSUNG

Hintergrund Bei Patienten mit rheumatoider Arthritis (RA) ist die Prävalenz von Stürzen im Vergleich zur gesunden Bevölkerung erhöht. Für Stürze bei RA wurden mehrere Risikofaktoren postuliert, darunter hohe Krankheitsaktivität, Gang- und Standunsicherheit, Muskelschwäche und Nichtbehandlung mit Biologika.

Ziel der Arbeit Wir untersuchten unsere Hypothese, dass sonographisch nachgewiesene Veränderungen an Knöcheln und Füßen bei RA-Patienten Stürze in dieser Population vorhersagen können. Nach unserem Kenntnisstand wurde dies noch nicht in einer früheren Studie untersucht.

Methoden Bei insgesamt 101 RA-Patienten erfolgten eine Beurteilung der Krankheitsaktivität, des Behinderungsgrads, der Ganggeschwindigkeit, der Gang- und Standsicherheit sowie eine klinische Untersuchung der Knöchel und Füße und eine MSUS-Untersuchung der Knöchel, Füße und Sehnen im Hinblick auf mögliche Risikofaktoren für Stürze.

Ergebnisse Der Berg-Gleichgewichtstest hatte die höchste Vorhersagekraft für Stürze (71,3 %), gefolgt von einem Ganggeschwindigkeitstest und einem eingeschränkten Bewegungsumfang (ROM) des rechten Subtalargelenks, jeweils mit einer Vorhersagekraft von 70,3 %. Von den sonographischen Befunden war die Erosion des ersten Metatarsophalangealgelenks (MTP) der genaueste Sturzprädiktor, gefolgt von der Erosion des Talonavikulargelenks und der Tenosynovitis der Knöcheldorsalflexoren, mit einer Fläche unter der Kurve von 0,656, 0,642 bzw. 0,614.

Schlussfolgerung Die Verwendung des MSUS als zusätzliches objektives Verfahren zur Vorhersage von Stürzen bei RA-Patienten wurde bislang noch nicht untersucht. Unsere Studie ergab, dass die klinische Untersuchung des Fußes und der Gang- und Standsicherheit eine überlegene und einfachere Methode zur Vorhersage von Stürzen bei RA-Patienten ist als die Verwendung von Ultraschall.

Key words

falls - ankle - rheumatoid arthritis - musculoskeletal ultrasound - predictors

Schlüsselwörter

Rheumatoide Arthritis - Stürze - Prädiktoren - Ultraschall des Bewegungsapparates - Knöchel


Publication History

Article published online:
16 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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