Generic placeholder image

Current Rheumatology Reviews

Author(s): Ali Erman Kent*, Emre Gürses, Figen Karabekiroğlu and Aydan Genç

DOI: 10.2174/1573397119666230828162611

DownloadDownload PDF Flyer Cite As
Balance Impairment in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis

Page: [426 - 434] Pages: 9

  • * (Excluding Mailing and Handling)

Abstract

Background: Balance weaknesses related to mobility and fall risk in patients with rheumatic diseases are well-known. Vestibular dysfunction could negatively contribute to the balance ability of this patient population. This study aims to investigate the effects of Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS), among the most common rheumatic diseases, on postural balance related to vestibular function.

Methods: Seventy-eight participants were grouped as RA (n=34, 43%), AS (n=24, 30.7%), and the control group consisted of healthy individuals (n=20, 25.6%). Cervical Vestibular Evoked Myogenic Potentials (cVEMP) test, which assesses the vestibular function objectively, Dizziness Handicap Inventory (DHI), which evaluates vertigo subjectively, and Berg Balance Scale (BBS) were performed.

Results: Different degrees of VEMP latency prolongations were found in the AS and RA groups. Right, and left ear N1 latencies were significantly longer in the AS group than in RA and control. Right ear P1 latency prolongation was statistically significant in the RA group. Amplitude asymmetry ratio (AAR) was found to be considerably higher in the RA and AS groups than in the control group (p < 0.05). The mean BBS score in the AS group was below the fall risk score of 45. A negative statistically significant effect was observed between latency prolongation and BBS in AS groups.

Conclusion: The abnormal VEMP findings in individuals with RA and AS shows inner ear vestibular system dysfunction. This vestibular impairment strictly contributes to their postural imbalance and requires a focused vestibular rehabilitation program for balance treatment.

Graphical Abstract

[1]
Bultink IEM, Vis M, van der Horst-Bruinsma IE , Lems WF. Inflammatory rheumatic disorders and bone. Curr Rheumatol Rep 2012; 14(3): 224-30.
[http://dx.doi.org/10.1007/s11926-012-0252-8] [PMID: 22477520]
[2]
Rein P, Mueller RB. Treatment with biologicals in rheumatoid arthritis: An overview. Rheumatol Ther 2017; 4(2): 247-61.
[http://dx.doi.org/10.1007/s40744-017-0073-3] [PMID: 28831712]
[3]
Sari İ, Öztürk MA, Akkoç N. Treatment of ankylosing spondylitis. Turk J Med Sci 2015; 45(2): 416-30.
[http://dx.doi.org/10.3906/sag-1401-79] [PMID: 26084136]
[4]
Bot SD, Caspers M, Van Royen BJ, Toussaint HM, Kingma I. Biomechanical analysis of posture in patients with spinal kyphosis due to ankylosing spondylitis: A pilot study. Rheumatology 1999; 38(5): 441-3.
[http://dx.doi.org/10.1093/rheumatology/38.5.441] [PMID: 10371282]
[5]
Vergara ME, O’Shea FD, Inman RD, Gage WH. Postural control is altered in patients with ankylosing spondylitis. Clin Biomech 2012; 27(4): 334-40.
[http://dx.doi.org/10.1016/j.clinbiomech.2011.10.016] [PMID: 22113076]
[6]
Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: Measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 2008; 37(1): 19-24.
[http://dx.doi.org/10.1093/ageing/afm169] [PMID: 18194967]
[7]
Zonzini GJ, Bértolo BM, Nunes SC, et al. Disease-related outcomes influence prevalence of falls in people with rheumatoid arthritis. Ann Phys Rehabil Med 2019; 62(2): 84-91.
[http://dx.doi.org/10.1016/j.rehab.2018.09.003] [PMID: 30278237]
[8]
Rome K, Dixon J, Gray M, Woodley R. Evaluation of static and dynamic postural stability in established rheumatoid arthritis: Exploratory study. Clin Biomech 2009; 24(6): 524-6.
[http://dx.doi.org/10.1016/j.clinbiomech.2009.03.005] [PMID: 19361898]
[9]
De Lorenzis E, Crudo F, Fedele AL, et al. Postural control and disability in patients with early rheumatoid arthritis. Clin Exp Rheumatol 2021; 39(6): 1369-77.
[http://dx.doi.org/10.55563/clinexprheumatol/hkfeur] [PMID: 33427617]
[10]
Elbeltagy R, Galhom D, Hammad M, Dawa G. Audio-vestibular dysfunction in rheumatoid arthritis: An undervalued extra-articular feature. Ind J Otol 2018; 24(1): 47-52.
[http://dx.doi.org/10.4103/indianjotol.INDIANJOTOL_26_18]
[11]
Özgür A, Serdaroğlu BM, Terzi S, Coşkun ZÖ, Dursun E. Vestibular evoked myogenic potentials in patients with ankylosing spondylitis. Eur Arch Otorhinolaryngol 2016; 273(10): 2953-7.
[http://dx.doi.org/10.1007/s00405-015-3882-4] [PMID: 26742904]
[12]
Özkırış M, Kapusuz Z, Günaydın İ, Kubilay U, Pırtı İ, Saydam L. Does rheumatoid arthritis have an effect on audiovestibular tests? Eur Arch Otorhinolaryngol 2014; 271(6): 1383-7.
[http://dx.doi.org/10.1007/s00405-013-2551-8] [PMID: 23665746]
[13]
Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol 2016; 68(1): 1-26.
[http://dx.doi.org/10.1002/art.39480] [PMID: 26545940]
[14]
Elolemy G, Aboughanima A, Ganeb S, Elziat H. Health-related quality of life in patients with ankylosing spondylitis: Relationship with disease-related variables. Curr Rheumatol Rev 2020; 16(4): 311-8.
[http://dx.doi.org/10.2174/18756360MTAxwNjIp5] [PMID: 31656154]
[15]
Sahin F, Yilmaz F, Ozmaden A, Kotevoglu N, Sahin T, Kuran B. Reliability and validity of the turkish version of the berg balance scale. J Geriatr Phys Ther 2008; 31(1): 32-7.
[http://dx.doi.org/10.1519/00139143-200831010-00006] [PMID: 18489806]
[16]
Berg K, Wood-Dauphine S, Williams JI, Gayton D. Measuring balance in the elderly: Preliminary development of an instrument. Physiother Can 1989; 41(6): 304-11.
[http://dx.doi.org/10.3138/ptc.41.6.304]
[17]
Wang J, Gong J, Sui X, Wang L, Zhu L, Sun D. An effect analysis of vestibular rehabilitation training in vertigo treatment. Am J Transl Res 2021; 13(4): 3494-500.
[PMID: 34017527]
[18]
Canbal M, Cebeci S, Duyan G, Kurtaran H, Arslan I. Study of reliability and validity for the Turkish version of dizziness handicap inventory. TJTFP 2016; 10(1): 1.
[http://dx.doi.org/10.5455/tjfmpc.198514]
[19]
Jacobson GP, Newman CW, Hunter L, Balzer GK. Balance function test correlates of the Dizziness Handicap Inventory. J Am Acad Audiol 1991; 2(4): 253-60.
[PMID: 1837740]
[20]
Kakani RS, Mehra YN, Deodhar SD, Mann SB, Mehta S. Audiovestibular functions in rheumatoid arthritis. J Otolaryngol 1990; 19(2): 100-2.
[PMID: 2348502]
[21]
King J, Young C, Highton J, Smith PF, Darlington CL. Vestibulo-ocular, optokinetic and postural function in humans with rheumatoid arthritis. Neurosci Lett 2002; 328(2): 77-80.
[http://dx.doi.org/10.1016/S0304-3940(02)00219-7] [PMID: 12133559]
[22]
Heydari N, Hajiabolhassani F, Fatahi J, Movaseghi S, Jalaie S. Vestibular evoked myogenic potentials in patients with rheumatoid arthritis. Med J Islam Repub Iran 2015; 29: 216-21.
[PMID: 26478874]
[23]
Erbek SS, Erbek HS, Yilmaz S, Topal O, Yucel E, Ozluoglu LN. Cochleovestibular dysfunction in ankylosing spondylitis. Audiol Neurotol 2006; 11(5): 294-300.
[http://dx.doi.org/10.1159/000094078] [PMID: 16790991]
[24]
Toprak CŞ, Duruöz MT, Gündüz OH. Static and dynamic balance disorders in patients with rheumatoid arthritis and relationships with lower extremity function and deformities: A prospective controlled study. Arch Rheumatol 2018; 33(3): 328-34.
[http://dx.doi.org/10.5606/ArchRheumatol.2018.6720] [PMID: 30632523]
[25]
Penêda JF, Lima NB, Monteiro F, Silva JV, Gama R, Condé A. Immune-mediated inner ear disease: Diagnostic and therapeutic approaches. Acta Otorrinolaringologica (English Edition) 2019; 70(2): 97-104.
[http://dx.doi.org/10.1016/j.otoeng.2017.08.016] [PMID: 29525415]
[26]
Goodall AF, Siddiq MA. Current understanding of the pathogenesis of autoimmune inner ear disease: A review. Clin Otolaryngol 2015; 40(5): 412-9.
[http://dx.doi.org/10.1111/coa.12432] [PMID: 25847404]
[27]
Das S, Bakshi SS, Seepana R. Demystifying autoimmune inner ear disease. Eur Arch Otorhinolaryngol 2019; 276(12): 3267-74.
[http://dx.doi.org/10.1007/s00405-019-05681-5] [PMID: 31605190]
[28]
Norén AM, Bogren U, Bolin J, Stenström C. Balance assessment in patients with peripheral arthritis: applicability and reliability of some clinical assessments. Physiother Res Int 2001; 6(4): 193-204.
[http://dx.doi.org/10.1002/pri.228] [PMID: 11833242]
[29]
Souza MC, Tutiya GC, Jones A, Junior LI, Natour J. Assessment of functional balance and quality of life among patients with ankylosing spondylitis. Rev Bras Reumatol 2008; 48(5): 274-7.
[http://dx.doi.org/10.1590/S0482-50042008000500004]
[30]
Ertugrul O, Mutlu A, Zindanci , Cam OH, Ozluoglu L. Audiological and vestibular measurements in Behçet’s disease. Eur Arch Otorhinolaryngol 2019; 276(6): 1625-32.
[http://dx.doi.org/10.1007/s00405-019-05403-x] [PMID: 30929056]
[31]
Kirazli G, Hepkarsi S, Kirazli T. Evaluation of high frequency horizontal VOR parameters in patients with chronic bilateral and unilateral peripheral vestibulopathy: A preliminary study. Acta Otolaryngol 2020; 140(12): 1007-12.
[http://dx.doi.org/10.1080/00016489.2020.1810314] [PMID: 32862738]