“Although it seems obvious that fatigue could contribute to a fall, I didn’t realize that this would be such a problem to the participants and that it may be more important than some of the other fall risk factors, such as poor balance or pain,” Stanmore says.

An important point, notes Stanmore, is that three of the causes of falls are modifiable. “It is not always easy to modify the risk factors, however there are things that professionals can do to help prevent falls in people with RA,” she says.

Stanmore says patients should be prescribed psychotropic medicines with caution, with regular reviews and should take them no longer than necessary. “In older people, we know that gradual withdrawal of psychotropic medication can reduce the rate of falls and this approach may also be effective in patients with rheumatoid arthritis,” she says. “There is some evidence that fatigue levels [decrease] with disease-modifying anti-rheumatic drugs (DMARDs) and anti-TNF therapy, and exercise can also be helpful for some individuals.”

The study authors plan to use their findings to develop screening tools to identify RA patients with the highest fall risk and they hope to begin to develop fall prevention programs that focus on the modifiable risk factors to prevent future falls and related injuries in this population group.

Stanmore says they are also wrapping up a study about fear of falling, which she says is an important area of future research too. “This is an area that can be as debilitating as an actual fall as patients can become socially isolated, depressed and less active which can then lead to an increased risk of a fall,” she explains. “We have found that this is a severe problem for people with RA.”


Terry L. Moore , MD, director of the division of rheumatology at St Louis University School of Medicine in Missouri says the information in this study is useful for doctors and patients.

While he believes that these are things most rheumatologists know, he says it is information that could prove especially helpful to other medical professionals who see patients with RA, but don’t specialize in the condition.

“Patients and sometimes primary care and family practitioners might not know or be aware, and they might add on medications to try and relieve pain or decrease depression and they may add to the problem,” he explains.

Dr. Moore says even if you think a fall isn’t a big deal, it’s important to discuss it with your doctor because your doctor can take steps to address the underlying causes – and reduce your risk of another fall. For example, your doctor can try to reduce your inflammation in order to lessen joint and muscle pain and improve fatigue. Or make sure you are getting physical therapy to strengthen your muscles, or analyze your use of psychotropic medications and/or corticosteroids (which can weaken bones).