A new study published recently online in Arthritis Care & Research zeroes in on some of the main reasons why adults with rheumatoid arthritis (RA) of all ages – even patients as young as 18 – are more prone to falls than people in the general population.

The top predictor? A history of falls in the previous year. Other important risk factors include fatigue; psychotropic drugs (psychiatric medicines that alter chemical levels in the brain which impact mood and behavior) to treat anxiety, depression or sleeping problems; and swollen and tender joints in the lower limbs.

“Falls are not just random events but may be predicted,” explains lead author Emma K. Stanmore, PhD, a lecturer in nursing at the University of Manchester in England.

“The study has highlighted many risk factors in people with RA that are associated with falls and those which could be modified to prevent further falls,” she says. The authors write that falls can lead to hip fractures, hospital admissions and other serious consequences such as a fear of falling and a diminished quality of life.

Causes of falls in older people have been well researched. For example, one study published online last October in The Lancet discovered that incorrect weight shifting, tripping and bumping into things were often the causes of falls among an elderly population.

But less is known about falls among people with RA despite the fact that previous studies have shown that they are at increased risk of falling. In fact, estimates of the proportion of people with RA who fall annually range from 10 to 54 percent.

The researchers say their study is the first large one to follow RA patients prospectively for one year, rather than simply asking them to recall falls they had in the past.

The participants (386 women and 173 men), were recruited from four different rheumatology outpatient clinics in northwest England. The age range was between 18 and 88, with an average age of approximately 62. In addition to physical exams, the participants sent in monthly calendar noting their falls and were contacted monthly by telephone.

Results show 36 percent had at least one fall during the one-year follow-up period of the study – a rate researchers say is higher than the 30 percent typically seen among people older than age 65.

Previous falls were the biggest predictor of future falls. Those who reported one fall the year before the study began were more than three times as likely to fall during the year researchers followed them than participants without a history of falls. Falling more than once in the year before the study more than quadrupled the fall risk during the study period.

Among the other risk factors, having swollen or tender hips, knees or ankles doubled the risk of a fall. Taking psychotropic medicines more than doubled the risk. And when it came to analyzing a patient’s fatigue levels, every added point on the scale used by researchers to measure fatigue raised the fall risk by 10 percent.