Previous falls, fatigue, and swollen joints increase the risk for falls. Here are some ways to prevent them.

A rheumatoid arthritis flare often means decreased mobility but also a higher risk for accidental falls. 

“Patients with rheumatoid arthritis (RA) are more prone to falls due to their muscle and joint characteristics,” said Gustavo J. Almeida, PT, MS, a research physical therapist in the department of physical therapy at the School of Health and Rehabilitation Sciences at the University of Pittsburgh. “Muscle weakness, fatigue, and joint pain might make patients with RA shift their body weight towards the pain-free limb to compensate for pain or fatigue.” That, in turn, puts you at greater risk for falls.

You can rebalance the odds in your favor by taking some smart steps to manage your RA and prevent falls at the same time with rheumatoid arthritis physical therapy and other strategies.

Rheumatoid Arthritis: Why Falls Are More Likely

A common reason for falls with RA is that your joints just give way, according to a study published in the May 2013 issue of Arthritis Care & Research. Another factor, said Emma K. Stanmore, PhD, MRes, a lecturer in Nursing at the University of Manchester in England and a lead author of that study, is the use of psychotropic medications, such as antidepressants and stimulants. Patients with RA may also have other health problems that contribute to the risk for falling, including impaired vision, osteoarthritis, and Parkinson’s disease, added Stanmore.

Another study by Stanmore, published in the February 2013 issue of Arthritis Care & Research found that a history of multiple falls in the previous 12 months was the biggest factor for predicting falls in those with RA.

Falls beget falls. “You never usually just have one fall. They’re almost always followed by others,” agreed Eric Robertson, PT, DPT, assistant professor of physical therapy at Regis University in Denver.

The Consequences of Falls With Rheumatoid Arthritis: Hip and Other Injuries

The chance for severe injuries from falls is always a concern for those with RA, said Robertson. “Fragile joints could lead to more severe injuries,” he explained.

If you fall, at a minimum you’re likely to get bruises and experience pain, said Almeida. More serious injuries are also possible, such as head injuries and fractures of the wrist, arm, and hip. Wrist injuries are common because people often put out an arm to catch themselves, putting pressure on the wrist.

Stanmore's May 2013 study found that of the 598 falls participants had, more than 50 percent led to moderate injuries, including some head injuries and fractures. Nearly 9 percent required emergency medical treatment.

Hip fractures are a great risk and a serious consequence of falls, especially for those living with RA. These injuries require more attention from families and health professionals, Almeida said.

Three Steps to Preventing Falls

You don't have to resign yourself to falling and risking injury. Think fall prevention. First, take a look at your living and work environment, recommends Robertson. Eliminate or move items that are common tripping hazards, such as throw rugs and clutter on the floor. Always do your best to avoid slippery floors and make sure you have sufficient lighting in and around your home, added Stanmore. Patients with RA sometimes work with an occupational therapist or physical therapist to review their home for fall hazards and eliminate them.

A second move is to work with a physical therapist on the right exercise plan to strengthen your muscles and help you regain confidence in your movements. A physical therapist will also be able to investigate your specific fall-related risk factors to help you reduce them.

Next, stay active overall. “The problem with falls is that once you fall, you are prone to fall again and again because you lose your confidence,” said Almeida. “People with RA should try to be as active as possible to maintain their muscle strength and conditioning.” A mix of water activities such as water aerobics along with walking, biking, or other exercises that strengthen the lower extremities can help to increase strength and improve conditioning.

An added benefit of exercise is that it can help reduce fatigue and provide relief to swollen joints—two more factors that raise your fall risk, said Robertson.