Postural imbalance in patients with rheumatoid arthritis: a cross-sectional study

The aim of this study was to evaluate postural balance in patients with rheumatoid arthritis and identify factors associated with balance impairment.

This cross-sectional case-control study included 101 patients with rheumatoid arthritis and 94 healthy controls recruited at a single tertiary referral center between March 2024 and April 2025. Epidemiological and clinical data, including disease activity, current treatments, and the number of falls during the previous year, were obtained through medical record review and direct patient interviews. Balance was assessed using the Berg Balance Scale, and handgrip strength was measured with a Jamar® dynamometer.

Patients with rheumatoid arthritis had significantly lower Berg Balance Scale scores (p<0.0001) and a markedly higher likelihood of experiencing falls than controls (OR 6.2; 95%CI 1.48-28.2). In univariate analysis, age (p<0.0001), handgrip strength (p=0.002), hypertension (p=0.02), tobacco exposure (p=0.0008), antimalarial use (p=0.02), and methotrexate use (p=0.007) were significantly associated with Berg Balance Scale scores. However, after multivariable adjustment, only antimalarial use (β=-2.75;95%CI -5.12 to -0.38; p=0.02), handgrip strength (β=0.09; 95%CI 0.01-0.17; p=0.01), and tobacco exposure (β=-1.90; 95%CI -3.20 to -0.62; p=0.004) remained independently associated with balance performance.

Postural imbalance appears to be an important and potentially modifiable feature of rheumatoid arthritis. Routine balance assessment, together with interventions targeting muscle strength and smoking cessation, may help reduce fall risk and improve functional outcomes. Further studies are needed to clarify the relationship between antimalarial use and balance impairment.