Rheumatoid Arthritis (RA) is a chronic autoimmune inflammatory disorder where the immune system mistakenly attacks the lining of the joints. This systemic condition causes pain, swelling, and stiffness, but its effects extend far beyond localized joint damage. RA can definitively cause balance problems by introducing multiple factors that compromise stability. These issues arise from structural damage in the spine, altered mechanics in the lower limbs, and damage to the nervous system.
The Critical Role of Cervical Spine Instability
One of the most serious causes of balance problems in RA stems from involvement of the neck, or cervical spine. RA frequently targets the upper cervical joints, specifically the atlantoaxial joint (C1 and C2 vertebrae). This joint allows for significant head rotation and is normally stabilized by strong ligaments.
Chronic inflammation leads to the destruction of ligaments and bony erosion in this region. This damage causes the vertebrae to shift out of alignment, a condition known as atlantoaxial subluxation. This instability directly affects the body’s balance mechanisms.
In advanced cases, shifting vertebrae can compress the spinal cord, a condition called cervical myelopathy. Spinal cord compression leads to clumsiness, loss of coordination, and difficulty walking, resulting in severe balance impairment and increased fall risk. Since this complication can progress without localized neck pain, screening for cervical instability is necessary in managing long-standing RA.
How Joint Damage and Systemic Inflammation Affect Gait
Beyond the spine, chronic inflammation and progressive joint damage in the lower extremities compromise the ability to walk steadily. The ankles, knees, and feet are common targets of RA inflammation. Synovial tissue swelling and subsequent erosion lead to pain and structural deformities.
This joint destruction causes people to alter their natural walking pattern, resulting in a protective, or antalgic, gait. This gait minimizes weight-bearing on painful areas.
This altered gait is inefficient and can lead to muscle atrophy and weakness in the affected limbs, compounding the instability. Foot deformities, such as bunions or hammer toes, alter the foot’s contact with the ground, reducing the stable base needed for balance. The cumulative effect of pain, reduced joint mobility, and mechanical changes significantly increases the risk of stumbling and falling.
Proprioception Loss and Neuropathy
Balance is heavily reliant on the nervous system’s ability to sense the body’s position in space, a function known as proprioception. Rheumatoid arthritis can impair this sensory feedback loop through a complication called peripheral neuropathy. Peripheral neuropathy is damage to the nerves outside the brain and spinal cord, occurring in up to 40% of RA patients.
Inflammation or compression, such as in carpal tunnel syndrome, can damage these peripheral nerves that transmit sensory information from the limbs to the brain. When nerves in the feet and legs are affected, the brain receives inaccurate or diminished information about the limbs’ position relative to the ground. This loss of sensory awareness makes maintaining a stable posture difficult, especially when walking on uneven surfaces.
Therapeutic Strategies for Improving Stability
Managing balance issues in RA requires a comprehensive approach focused on controlling systemic inflammation and restoring function. The primary medical goal is to reduce disease activity using pharmacologic treatments like Disease-Modifying Anti-Rheumatic Drugs (DMARDs) and Biologics. Controlling inflammation helps halt the progression of joint and ligament destruction, which causes spinal instability and peripheral joint damage.
Physical therapy protocols are an important non-pharmacologic component of management. They focus on strengthening muscles that support postural alignment. Therapists often prescribe balance exercises, sometimes called proprioceptive training, to help the body compensate for compromised sensory feedback.
Occupational therapy plays a role by assessing the home environment and suggesting modifications to mitigate the risk of falls. Assistive devices, including canes or walkers, provide external stability and a broader base of support for those with significant gait changes. Custom orthotics, braces, and splints are frequently used to improve alignment and stability in damaged foot and ankle joints. By combining aggressive medical therapy with targeted rehabilitation, it is possible to mitigate the physical and neurological factors that compromise stability in people living with RA.