{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:02:55Z","timestamp":1791198175949,"version":"4.1.0"},"reference-count":25,"publisher":"FapUNIFESP (SciELO)","issue":"9","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  OBJECTIVE: The aim of this study was to evaluate postural balance in patients with rheumatoid arthritis and identify factors associated with balance impairment.  METHODS: This cross-sectional case\u2013control 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\u00ae dynamometer.  RESULTS: Patients with rheumatoid arthritis had significantly lower Berg Balance Scale scores (p&lt;0.0001) and a markedly higher likelihood of experiencing falls than controls (OR 6.2; 95%CI 1.48\u201328.2). In univariate analysis, age (p&lt;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 (\u03b2=-2.75;95%CI -5.12 to -0.38; p=0.02), handgrip strength (\u03b2=0.09; 95%CI 0.01\u20130.17; p=0.01), and tobacco exposure (\u03b2=-1.90; 95%CI -3.20 to -0.62; p=0.004) remained independently associated with balance performance.  CONCLUSION: 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.<\/jats:p>","DOI":"10.1590\/1806-9282.20260317","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:39:45Z","timestamp":1791196785000},"source":"Crossref","is-referenced-by-count":0,"title":["Postural imbalance in patients with rheumatoid arthritis: a cross-sectional study"],"prefix":"10.1590","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9292-8988","authenticated-orcid":false,"given":"Ana Luisa","family":"Trevisan","sequence":"first","affiliation":[{"name":"Mackenzie Evangelical School of Medicine of Paran\u00e1","place":["Curitiba, PR, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8207-6021","authenticated-orcid":false,"given":"Bruna","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Mackenzie Evangelical School of Medicine of Paran\u00e1","place":["Curitiba, PR, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8799-1228","authenticated-orcid":false,"given":"Clara Mayumi","family":"Mikami","sequence":"additional","affiliation":[{"name":"Mackenzie Evangelical School of Medicine of Paran\u00e1","place":["Curitiba, PR, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0834-8207","authenticated-orcid":false,"given":"Naira Alessandra","family":"Hurmus","sequence":"additional","affiliation":[{"name":"Mackenzie Evangelical School of Medicine of Paran\u00e1","place":["Curitiba, PR, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7699-3542","authenticated-orcid":false,"given":"Thelma Larocca","family":"Skare","sequence":"additional","affiliation":[{"name":"Mackenzie Evangelical School of Medicine of Paran\u00e1","place":["Curitiba, PR, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1234-8093","authenticated-orcid":false,"given":"Renato","family":"Nisihara","sequence":"additional","affiliation":[{"name":"Mackenzie Evangelical School of Medicine of Paran\u00e1","place":["Curitiba, PR, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5292-2777","authenticated-orcid":false,"given":"Barbara Stadler","family":"Kahlow","sequence":"additional","affiliation":[{"name":"Mackenzie Evangelical School of Medicine of Paran\u00e1","place":["Curitiba, PR, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"issue":"1","key":"ref1","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1186\/s12891-022-05489-1","article-title":"Balance and prospective falls in patients with rheumatoid arthritis","volume":"23","author":"Wiegmann S","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"issue":"2","key":"ref2","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.jbmt.2015.12.008","article-title":"The contribution of postural balance analysis in older adult fallers: a narrative review","volume":"20","author":"Pizzigalli L","year":"2016","journal-title":"J Bodyw Mov Ther"},{"issue":"7","key":"ref3","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1111\/imj.70065","article-title":"Dual-energy X-ray absorptiometry and anti-osteoporotic medication use in Australian patients with early rheumatoid arthritis using data from the Australian Rheumatology Association Database","volume":"55","author":"Lyon A","year":"2025","journal-title":"Intern Med J"},{"issue":"4","key":"ref4","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s00774-025-01598-8","article-title":"Increasing fracture incidence over 13 years in patients with rheumatoid arthritis from the IORRA cohort","volume":"43","author":"Furuya T","year":"2025","journal-title":"J Bone Miner Metab"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"152186","DOI":"10.1016\/j.semarthrit.2023.152186","article-title":"Prevalence and risk factors of falls in adults with rheumatoid arthritis: a systematic review and meta-analysis","volume":"60","author":"Guo X","year":"2023","journal-title":"Semin Arthritis Rheum"},{"issue":"11","key":"ref6","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1007\/s10067-009-1229-5","article-title":"Associated factors for falls and fear of falling in Japanese patients with rheumatoid arthritis","volume":"28","author":"Furuya T","year":"2009","journal-title":"Clin Rheumatol"},{"issue":"9","key":"ref7","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1002\/art.27584","article-title":"2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology\/European League Against Rheumatism collaborative initiative","volume":"62","author":"Aletaha D","year":"2010","journal-title":"Arthritis Rheum"},{"issue":"6","key":"ref8","first-page":"477","article-title":"Correlation of rheumatoid arthritis activity indexes (Disease Activity Score 28 measured with ESR and CRP, Simplified Disease Activity Index and Clinical Disease Activity Index) and agreement of disease activity states with various cut-off points in a Northeastern Brazilian population","volume":"55","author":"Medeiros MM","year":"2015","journal-title":"Rev Bras Reumatol"},{"issue":"Suppl 2","key":"ref9","first-page":"S7","article-title":"Measuring balance in the elderly: validation of an instrument","volume":"83","author":"Berg KO","year":"1992","journal-title":"Can J Public Health"},{"issue":"8","key":"ref10","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1093\/ptj\/77.8.812","article-title":"Predicting the probability for falls in community-dwelling older adults","volume":"77","author":"Shumway-Cook A","year":"1997","journal-title":"Phys Ther"},{"issue":"9990","key":"ref11","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0140-6736(14)62000-6","article-title":"Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study","volume":"386","author":"Leong DP","year":"2015","journal-title":"Lancet"},{"issue":"12","key":"ref12","doi-asserted-by":"crossref","first-page":"4273","DOI":"10.3390\/ijerph17124273","article-title":"Handgrip strength in young adults: association with anthropometric variables and laterality","volume":"17","author":"Zaccagni L","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"e68082","DOI":"10.2196\/68082","article-title":"Neuromuscular electrical stimulation to maximize hip abductor strength and reduce fall risk in older veterans: protocol for a randomized controlled trial","volume":"14","author":"Friedman B","year":"2025","journal-title":"JMIR Res Protoc"},{"issue":"3","key":"ref14","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1093\/mr\/roac095","article-title":"Management of sarcopenia in patients with rheumatoid arthritis","volume":"33","author":"Torii M","year":"2023","journal-title":"Mod Rheumatol"},{"issue":"4","key":"ref15","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/s41584-023-00921-9","article-title":"Rheumatoid sarcopenia: loss of skeletal muscle strength and mass in rheumatoid arthritis","volume":"19","author":"Bennett JL","year":"2023","journal-title":"Nat Rev Rheumatol"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"1759720X211015006","DOI":"10.1177\/1759720X211015006","article-title":"Body composition in patients with rheumatoid arthritis: a narrative literature review","volume":"13","author":"Letarouilly JG","year":"2021","journal-title":"Ther Adv Musculoskelet Dis"},{"issue":"1","key":"ref17","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1038\/s41378-025-00940-4","article-title":"Recent advances in bio-microsystem integration and Lab-on-PCB technology","volume":"11","author":"Papamatthaiou S","year":"2025","journal-title":"Microsyst Nanoeng"},{"issue":"4","key":"ref18","doi-asserted-by":"crossref","first-page":"551","DOI":"10.3390\/medicina61040551","article-title":"The characteristic of muscle function for sarcopenia in patients with rheumatoid arthritis: a large-scale real-world cross-sectional study","volume":"61","author":"Jia PW","year":"2025","journal-title":"Medicina (Kaunas)"},{"issue":"2","key":"ref19","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.therap.2023.10.011","article-title":"Drug-induced hearing loss: listening to the latest advances","volume":"79","author":"Reynard P","year":"2024","journal-title":"Therapie"},{"issue":"7","key":"ref20","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1007\/s00296-021-04868-6","article-title":"Systemic toxicity of chloroquine and hydroxychloroquine: prevalence, mechanisms, risk factors, prognostic and screening possibilities","volume":"41","author":"Muller R","year":"2021","journal-title":"Rheumatol Int"},{"issue":"11","key":"ref21","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1007\/s10067-007-0662-6","article-title":"Chloroquine ototoxicity","volume":"26","author":"Bortoli R","year":"2007","journal-title":"Clin Rheumatol"},{"issue":"5","key":"ref22","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1007\/s12199-015-0457-3","article-title":"Relationship between cigarette smoking and one leg with eyes closed balance in Japanese men","volume":"20","author":"Saito T","year":"2015","journal-title":"Environ Health Prev Med"},{"issue":"2","key":"ref23","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/0196-0709(94)90061-2","article-title":"Smoking habits and postural stability","volume":"15","author":"Iki M","year":"1994","journal-title":"Am J Otolaryngol"},{"issue":"1","key":"ref24","doi-asserted-by":"crossref","DOI":"10.4081\/hls.2023.11159","article-title":"Evaluation of the static and dynamic balance in single and dual tasks among active smokers and non-smokers","volume":"11","author":"Rana Y","year":"2023","journal-title":"Healthcare Low-Resource Settings"},{"issue":"3","key":"ref25","doi-asserted-by":"crossref","first-page":"328","DOI":"10.5606\/ArchRheumatol.2018.6720","article-title":"Static and dynamic balance disorders in patients with rheumatoid arthritis and relationships with lower extremity function and deformities: a prospective controlled study","volume":"33","author":"Toprak C\u015e","year":"2018","journal-title":"Arch Rheumatol"}],"container-title":["Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0104-42302026000902211&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:39:48Z","timestamp":1791196788000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0104-42302026000902211&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":25,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026]]}},"alternative-id":["S0104-42302026000902211"],"URL":"https:\/\/doi.org\/10.1590\/1806-9282.20260317","relation":{},"ISSN":["1806-9282","0104-4230"],"issn-type":[{"value":"1806-9282","type":"electronic"},{"value":"0104-4230","type":"print"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e20260317"}}