Have you ever woken up with unexpected bruises or felt like you’re getting clumsier with age? It turns out rheumatoid arthritis (RA) can affect more than just your joints. Some people notice whole-body symptoms, such as difficulty balancing.

“I fell in the church parking lot today because my leg and knee didn’t support me, even with my cane,” said a myRAteam member. Another responded, “When I fell in the kitchen a couple of months ago, I got banged up pretty bad. My shoulders have been painful ever since, probably from trying to catch myself!”

Balance problems could be a symptom of RA, or they could be related to something else. Either way, finding the cause of balance issues can help prevent serious injuries and keep you safe and independent.

How Does Balance Work?

Balance is defined as controlling the body’s center of gravity with minimal swaying and maximum stability. Maintaining your balance is a complex process. There are two basic types of balance — dynamic and static. Static balance is when you’re standing still, and dynamic balance involves controlling your body while moving around.

Sensory input from your eyes and ears must work together with the muscles, bones, and joints to maintain your balance. Balance problems can happen when someone experiences vertigo (an inner ear condition that causes dizziness), unsteadiness on their feet, or disorientation or confusion about spatial surroundings. In addition, a lack of coordination or muscle strength can make balancing more difficult.

Balance Problems With RA

Joint pain and swelling are the main symptoms of RA and can make walking or doing essential chores difficult. Pain may cause instability and lead to frequent falls. If not treated from the beginning, changes in joints can lead to joint deformities. Those in the feet and lower extremities can especially compromise stability and range of motion. In addition, RA can weaken the muscles and impair the central nervous system, contributing to balance problems.

Balance problems can significantly affect your quality of life with rheumatoid arthritis, making other physical challenges worse. Simple daily tasks, such as walking, climbing stairs, or even standing up from a seated position, can become daunting and lead to a fear of falling. Fear of falling can cause people to avoid physical activity and even lead to social isolation.

If you experience sudden balance issues you didn’t have before, make sure to discuss them with your rheumatologist. They could be related to RA, medication side effects, or comorbidities (co-occurring health conditions) that would benefit from medical attention.

Other Health Conditions and Balance Problems

RA is associated with several comorbidities that can contribute to balance problems. Various types of heart disease can cause dizziness when you stand up. Neurological conditions like peripheral neuropathy can cause numbness, tingling, and reduced sensation in your feet and legs, affecting balance. Osteoporosis, another common comorbidity in RA, can increase your risk of fractures before or after a fall.

Are Balance Problems a Side Effect of RA Treatment?

Several medications list dizziness as a known side effect, including some prescriptions used to manage RA. Corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologics may have side effects that affect your balance. For example, corticosteroids can lead to fluid retention and electrolyte imbalances, which can contribute to blood pressure changes that cause dizziness. However, note that not everyone experiences these side effects, and the benefits of RA treatment often outweigh the potential risks.

Other Causes of Balance Problems

Sometimes, balance issues may not be directly related to RA. Lots of different organs must work properly for a person to maintain good balance. Along with the joints and muscles, problems with the eyes, inner ear, nerves, heart, or blood vessels can also affect your stability.

Some potential causes of balance problems not related to RA include:

• Abnormal heart rhythms — Certain types of heart disease can affect balance by making you feel lightheaded and dizzy.
• Benign paroxysmal positional vertigo (BPPV) — BPPV affects the inner ear, causing sudden, brief episodes of vertigo or spinning sensations triggered by certain head movements.
• Ear infections — Infections or inflammation of the inner ear can lead to temporary balance problems.
• Meniere’s disease — This inner ear disorder is characterized by intense vertigo, hearing loss, and ringing in the ear.
• Migraine — Severe headaches often cause dizziness and can affect the vestibular system, which controls balance.
• Ramsay Hunt syndrome — This infection is similar to shingles and may cause vertigo when it affects the ears.
• Dehydration — Lack of proper hydration can lead to low blood pressure and dizziness.

Many conditions can impair your balance. Although you may initially suspect RA is to blame for difficulties with balance, you may need to undergo a range of tests before your health care provider can make a confident diagnosis and treatment plan.

Managing Balance Problems

For individuals with RA experiencing balance problems, it is crucial to address the issue proactively and put in safeguards to avoid injury. Living a healthy lifestyle by getting enough sleep, staying hydrated, and avoiding alcohol can help you maintain a better sense of balance and overall well-being. For balance problems unrelated to RA, you may need prescription medication or surgery to get your symptoms under control.

Seek the guidance of a physical therapist for exercises to improve strength, flexibility, and balance. Engaging in regular low-impact exercises, like swimming or tai chi, can help improve balance and reduce joint pain. “I’ve started using a wobble board in my exercise program. It’s helping my feet and ankles become stronger. Plus, it strengthens balance,” shared a myRAteam member.

Always be sure to wear supportive, well-fitted shoes with nonslip soles to help with stability. Another member explained, “I wear insoles made by my orthopedic surgeon. … It has made an extraordinary difference in my pain and ability to walk properly! I took the insoles out of my wide-fit walking shoes, then slipped them in.”

You can make your living space safer by removing hazards, improving lighting, and adding handrails in areas prone to slips and falls. Mobility aids, such as canes or walkers, can provide additional support and stability. “I have balance issues and use a cane when needed,” said a myRAteam member. “I think for me, it’s the side effects of my meds. I’ve had bad days when I had to use a walker. Fortunately, those days are few and far between.”

If you experience balance problems or any other symptoms, don’t hesitate to ask your rheumatologist for help. They can do tests, review your medications, and recommend treatments to help. Your health care team can help you understand the cause of balance problems and find solutions so you can maintain an active and fulfilling life despite challenges along the way.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 203,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

Have you noticed balance problems in your daily life? If so, have you tried physical therapy, assistive devices, or other treatment options to improve your stability? Share your suggestions in the comments below, or start a conversation by posting to your Activities feed.