A study showed that falls were common among participants with systemic lupus erythematosus (SLE), regardless of age.1
“Multiple intrinsic factors appear to be contributing to these falls, including loss of balance, weakness, joint instability, and pain…” wrote study investigator Chelsea R. Perfect, MD, MPH, from Duke University School of Medicine, and colleagues.1 “Extrinsic factors likely contributed to the high prevalence of falls, with nearly two-thirds of study participants reporting that they tripped or slipped during their fall.”
SLE is believed to accelerate the aging process due to stress, hormone alterations, and inflammation. The accelerated aging can put patients at risk of geriatric syndromes, including falls.2
In the Approaches to Positive, Patient-centered Experiences of Aging with Lupus (APPEAL) study, investigators assessed the burden of and risk factors for falls among patients with SLE regardless of age.1 They also examined what intrinsic and extrinsic factors contributed to the falls.
The team recruited 447 participants aged ≥ 18 years with validated SLE (40.9% aged ≥ 50 years, 91.7% female, and 82.6% Black) from the ongoing population-based Georgians Organized Against Lupus (GOAL) cohort in Atlanta. This sample included participants who had an APPEAL visit between October 8, 2019, and May 12, 2022.`
The median disease duration was 14.8 years, with median SLAQ and BILD scores of 11 and 2, respectively. The mean Short Physical Performance Battery score was 9.0, with balance and chair stand sub scores of 3.8 and 1.7, respectively. Most participants had mild limitations in basic and instrumental activities of daily living, with median scores of 6 and 9, respectively.1
Investigators also collected self-reported information on falls, including the number of falls and fall-related injuries requiring medical attention over the past year. They also collected self-reported perceived contributing factors.
Nearly a third of patients (30.7%) reported falling in the past year, with 19.2% falling at least twice. Contributing factors for falls included loss of balance (78.1%), slipping or tripping (64.2%), and weakness (53.3%).1
Neither age, sex, nor race was associated with falls. Although the study showed that participants aged ≥ 50 years were more likely to report falls than younger participants aged 18 – 34 years, this association was not statistically significant in the multivariable logistic regression analysis adjusted by age, sex, and race (adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI], 0.22 – 3.07). The presence of cognitive impairment was also not associated with a difference in falls.1
The study found that greater physical functioning (aOR, 0.50; 95% CI, 0.38–0.66) and performance (aOR, 0.78; 95% CI, 0.71–0.87) were associated with lower odds of falls. Risk factors associated with greater odds of falls included a greater SLE activity (aOR, 1.78; 95% CI, 1.44 – 2.21), greater SLE damage (aOR, 1.22; 95% CI, 1.00 – 1.49), and depressive symptoms (aOR, 1.43; 95% CI, 1.14 to 1.80). Additionally, obesity (aOR, 1.58; 95% CI, 1.04 to 2.41), greater Basic Activities of Daily Living scores (aOR, 1.29; 95% CI, 1.16 to 1.43), and greater Instrumental Activities of Daily Living scores (aOR, 1.14; 95% CI, 1.07 to 1.21) were linked to greater odds of a fall.1
Another risk factor was taking medication that increases the risk of falls, such as antidepressants (aOR, 1.82; 95% CI, 1.13 – 2.93), pain medications (aOR, 2.60; 95% CI, 1.68 – 4.00), and opioids (aOR, 4.52; 95% CI, 2.39 – 8.56). Steroids, sedatives, and antihypertensive medications were not associated with increased odds if a fall. Taking ≥ 10 medications, compared with ≥ 5 medications, was associated with a greater risk of falls (aOR, 3.36; 95% CI, 1.83 to 6.16).1
Furthermore, being currently employed versus unemployed was associated with a substantially lower odds of reporting falls (aOR, 0.61; 95% CI, 0.40 – 0.94). Additionally, high vs low physical activity was linked to lower odds of falls (OR, 0.33; 95% CI, 0.14 to 0.76).1
Sensitivity analyses showed that falls attributed to balance, weakness, or slipping had distinct risk patterns: balance-related falls were more strongly linked to disease activity, depressive symptoms, stress, and medication use; weakness-related falls were influenced by education and race; and slipping-related falls were most strongly tied to employment, physical activity, and depression.1
“Future studies could focus on understanding if there are differences between SLE individuals and the general population regarding severity of the falls, incidence of injury, and sequelae of falls,” investigators wrote.1
References
Perfect CR, Bowling CB, Lim SS, et al. Falls Among Individuals With Systemic Lupus Erythematosus: An Observational Study. ACR Open Rheumatol. 2025;7(9):e70098. doi:10.1002/acr2.70098Byerly LK. Accelerated aging in primary care practice: seeing the downstream effects of social determinants of health. Presented at: 55th Annual Primary Care Review; February 12–16, 2024; Portland, OR.