Balance and falls in axial Spondyloarthritis: a cross sectional study

Background: Spondyloarthritis (SpA) patients may suffer from balance loss predisposing them to falls. Aim: To study balance impairment and falls in axial SpA patients and its association with clinical and epidemiological variables, disease activity, functional and metrology indexes. Methods: Cross-sectional study of 55 SpA patients with axial disease. Clinical and epidemiological data were collected from the charts. Balance was accessed by Berg Balance Scale (BBS). The following instruments were applied: ASDAS (Ankylosing Spondylitis Disease Activity Score)-ESR, ASDAS-CRP, BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), BASMI (Bath Ankylosing Spondylitis Metrology Index) and ASQoL (Ankylosing spondylitis quality of life questionnaire). The number of falls in the last year was obtained through direct questioning. Results: In this sample, 30.9% had high risk of falls by the BBS and 25.4% recalled having at least one fall in the last years. The BBS values were lower in those with white ethnic background (p=0.01), smokers (p=0.03) and with HLA-B27 (p=0.03) and correlated inversely with BASDAI (rho=-0.28), ASDAS-ESR (rho=-0.32) and ASDAS-CRP (rho=-0.33), BASFI (rho=-0.71; p < 0.0001), BASMI (rho=-0.80; p < 0.0001), ASQoL (rho=-0.57; p < 0.001) and age (rho=-0.50; p < 0.001). Linear multivariable analysis showed that BASFI and BASMI were independently associated with BBS (p=0.01 and < 0.0001 respectively). Patients with falls had lower BBS (p=0.03) and loss of balance correlated with impairment of the quality of life (rho=-0.56; p < 0.001). Conclusions: Balance is impaired in 1/3 of axial SpA patients and the BBS is associated mainly with functional and metrology indexes, showing that patients with severe cumulative damage are more affected.