Fear of Falling in Axial Spondyloarthritis and Rheumatoid Arthritis: A Comparative Cross-Sectional Analysis

Abstract

Objective: Fear of falling (FOF) is a clinically significant multidimensional construct in inflammatory rheumatic diseases. This study aimed to compare the prevalence and severity of FOF among patients with axial spondyloarthritis (AxSpA), rheumatoid arthritis (RA), and healthy controls and to identify independent clinical predictors of falls in each patient group. Methods: In this cross-sectional study, 57 patients fulfilling Assessment of Spondyloarthritis International Society classification criteria for AxSpA, 57 patients diagnosed with RA according to the 2010 ACR/EULAR criteria, and 50 healthy controls were enrolled. FOF was assessed using the 16-item Falls Efficacy Scale-International (FES-I; range 16-64). Fall history over the preceding 12 months was recorded. Disease-specific indices comprised Ankylosing Spondylitis Disease Activity Score-CRP (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Metrology Index (BASMI) for AxSpA, and 28-joint Disease Activity Score using C-reactive protein (DAS28-CRP) and Clinical Disease Activity Index (CDAI) for RA. Logistic regression analyses were performed separately for each patient cohort. Results: Falls efficacy scale-international scores differed significantly across groups (P < .001): RA 34.5 ± 8.8, AxSpA 27.6 ± 9.1, and control 18.9 ± 2.4. Fall prevalence over the preceding 12 months was 28.6% in AxSpA, 28.0% in controls, and 14.0% in RA (P = .008). Sex composition differed markedly between groups (RA 91.2% female; AxSpA 35.1% female), representing a confounding factor that could not be fully isolated. In the AxSpA cohort, age was the only variable reaching statistical significance in logistic regression (Odds Ratio 1.085; 95% CI: 1.029-1.156; P = .005). No examined variable achieved significance in the RA cohort; findings in both groups are constrained by limited statistical power. Conclusion: Fear of falling is significantly elevated in both AxSpA and RA compared with healthy controls. The observed betweendisease FES-I difference warrants cautious interpretation given the sex composition imbalance and the inadequate statistical power of logistic regression models. These findings provide preliminary evidence for disease-specific FOF mechanisms and establish a basis for appropriately powered, prospective investigations incorporating sex-stratified analyses, objective balance assessments, and psychological measures.