Falls Common Among Lupus Patients, Linked to Multiple Risk Factors: Study

Findings from the APPEAL study, published in ACR Open Rheumatology, reveal that falls are a frequent but underrecognized complication among individuals with systemic lupus erythematosus (SLE). Researchers analyzed data from 447 participants in a population-based cohort with validated SLE, where 91.7% were female and 82.6% were Black, and 40.9% were aged 50 years or older. Nearly one-third of patients (30.7%) reported at least one fall in the previous year, and 19.2% experienced recurrent falls (two or more). Importantly, age and sex were not associated with fall risk, suggesting that disease-related and psychosocial factors may play a greater role. Participants most often attributed their falls to loss of balance (78.1%), slipping or tripping (64.2%), and muscle weakness (53.3%). The analysis identified several clinical predictors of falls. Higher disease activity was significantly associated with increased fall risk (adjusted odds ratio [aOR] 1.78; 95% CI, 1.44–2.21), as was greater cumulative SLE-related damage (aOR 1.22; 95% CI, 1.00–1.49). Depressive symptoms were another independent contributor (aOR 1.43; 95% CI, 1.14–1.80), underscoring the influence of mental health on physical outcomes. Medication use also emerged as a key factor: patients taking antidepressants (aOR 1.82; 95% CI, 1.13–2.93), pain medications (aOR 2.60; 95% CI, 1.68–4.00), or opioids (aOR 4.52; 95% CI, 2.39–8.56) had markedly higher odds of falling. Conversely, higher physical performance was protective (aOR 0.78; 95% CI, 0.71–0.87). The study concludes that falls in SLE are not simply age-related, but rather linked to disease activity, mental health, and pharmacologic exposures. Given that 30% of patients reported at least one fall annually, the authors recommend incorporating fall risk assessment into standard lupus care. Potential preventive strategies include optimizing disease control, reviewing medications that increase fall risk, addressing depressive symptoms through screening and treatment, and encouraging physical therapy or targeted exercise to improve balance and strength.