Cervical proprioception, postural control, and pain: unraveling the interconnected challenges in rheumatoid arthritis

Abstract Background Rheumatoid arthritis (RA) is a chronic autoimmune disease that impairs proprioception and postural control, increasing fall risk and reducing quality of life. This study evaluated cervical proprioception and postural control in RA patients versus asymptomatic individuals, examine...

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Main Authors: Batool Abdulelah Alkhamis, Basant Hamdy Elrefaey, Khalid A. Alahmari, Ghada Mohammed Koura, Fareed F. Alfaya, Ravi Shankar Reddy
Format: Article
Language:English
Published: BMC 2025-02-01
Series:Journal of Orthopaedic Surgery and Research
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Online Access:https://doi.org/10.1186/s13018-025-05572-y
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author Batool Abdulelah Alkhamis
Basant Hamdy Elrefaey
Khalid A. Alahmari
Ghada Mohammed Koura
Fareed F. Alfaya
Ravi Shankar Reddy
author_facet Batool Abdulelah Alkhamis
Basant Hamdy Elrefaey
Khalid A. Alahmari
Ghada Mohammed Koura
Fareed F. Alfaya
Ravi Shankar Reddy
author_sort Batool Abdulelah Alkhamis
collection DOAJ
description Abstract Background Rheumatoid arthritis (RA) is a chronic autoimmune disease that impairs proprioception and postural control, increasing fall risk and reducing quality of life. This study evaluated cervical proprioception and postural control in RA patients versus asymptomatic individuals, examined their relationship within the RA group, and investigated pain’s mediating effects on this association. Methods In this cross-sectional study, 82 RA patients and 82 age- and gender-matched controls were recruited. Cervical proprioception was assessed using the Cervical Joint Position Error Test (CJPET), while postural control was evaluated via a stabilometric force platform measuring center-of-pressure length (L CoP), 95% confidence ellipse sway area (ESA 95%), and center-of-pressure velocity (V CoP). Statistical analyses included t-tests, correlation, regression, and mediation analysis to evaluate relationships and the role of pain in cervical proprioception and postural control. Results RA patients demonstrated significantly impaired cervical proprioception and postural control compared to controls (p < 0.001). Significant differences were observed in cervical flexion, extension, rotation, and postural control measures (L CoP, ESA 95%, and V CoP; p < 0.001 for all parameters). Pearson’s correlations revealed significant relationships between cervical proprioception and postural control parameters. Regression analysis indicated that cervical proprioception, particularly when combined with age and disease duration, significantly predicted postural control. Mediation analysis revealed that pain significantly mediated the relationship between cervical proprioception and postural control. Conclusions Cervical proprioception is significantly reduced in RA patients and strongly influences postural control. Pain serves as a key mediator in this relationship, emphasizing the need for effective pain management to enhance proprioceptive and postural functions in RA patients. These findings suggest that the insights from this cross-sectional study could inform future interventions aimed at enhancing proprioception and managing pain, which may significantly benefit RA patients’ postural stability and overall quality of life.
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spelling doaj-art-2d0864c86df2432eb40fe67f7eeccd6b2025-08-20T02:48:27ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-02-0120111110.1186/s13018-025-05572-yCervical proprioception, postural control, and pain: unraveling the interconnected challenges in rheumatoid arthritisBatool Abdulelah Alkhamis0Basant Hamdy Elrefaey1Khalid A. Alahmari2Ghada Mohammed Koura3Fareed F. Alfaya4Ravi Shankar Reddy5Program of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid UniversityProgram of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid UniversityProgram of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid UniversityProgram of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid UniversityDepartment of Orthopedic Surgery, College of Medicine, King Khalid UniversityProgram of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid UniversityAbstract Background Rheumatoid arthritis (RA) is a chronic autoimmune disease that impairs proprioception and postural control, increasing fall risk and reducing quality of life. This study evaluated cervical proprioception and postural control in RA patients versus asymptomatic individuals, examined their relationship within the RA group, and investigated pain’s mediating effects on this association. Methods In this cross-sectional study, 82 RA patients and 82 age- and gender-matched controls were recruited. Cervical proprioception was assessed using the Cervical Joint Position Error Test (CJPET), while postural control was evaluated via a stabilometric force platform measuring center-of-pressure length (L CoP), 95% confidence ellipse sway area (ESA 95%), and center-of-pressure velocity (V CoP). Statistical analyses included t-tests, correlation, regression, and mediation analysis to evaluate relationships and the role of pain in cervical proprioception and postural control. Results RA patients demonstrated significantly impaired cervical proprioception and postural control compared to controls (p < 0.001). Significant differences were observed in cervical flexion, extension, rotation, and postural control measures (L CoP, ESA 95%, and V CoP; p < 0.001 for all parameters). Pearson’s correlations revealed significant relationships between cervical proprioception and postural control parameters. Regression analysis indicated that cervical proprioception, particularly when combined with age and disease duration, significantly predicted postural control. Mediation analysis revealed that pain significantly mediated the relationship between cervical proprioception and postural control. Conclusions Cervical proprioception is significantly reduced in RA patients and strongly influences postural control. Pain serves as a key mediator in this relationship, emphasizing the need for effective pain management to enhance proprioceptive and postural functions in RA patients. These findings suggest that the insights from this cross-sectional study could inform future interventions aimed at enhancing proprioception and managing pain, which may significantly benefit RA patients’ postural stability and overall quality of life.https://doi.org/10.1186/s13018-025-05572-yRheumatoid arthritisProprioceptionPostural balancePainChronic painProprioception
spellingShingle Batool Abdulelah Alkhamis
Basant Hamdy Elrefaey
Khalid A. Alahmari
Ghada Mohammed Koura
Fareed F. Alfaya
Ravi Shankar Reddy
Cervical proprioception, postural control, and pain: unraveling the interconnected challenges in rheumatoid arthritis
Journal of Orthopaedic Surgery and Research
Rheumatoid arthritis
Proprioception
Postural balance
Pain
Chronic pain
Proprioception
title Cervical proprioception, postural control, and pain: unraveling the interconnected challenges in rheumatoid arthritis
title_full Cervical proprioception, postural control, and pain: unraveling the interconnected challenges in rheumatoid arthritis
title_fullStr Cervical proprioception, postural control, and pain: unraveling the interconnected challenges in rheumatoid arthritis
title_full_unstemmed Cervical proprioception, postural control, and pain: unraveling the interconnected challenges in rheumatoid arthritis
title_short Cervical proprioception, postural control, and pain: unraveling the interconnected challenges in rheumatoid arthritis
title_sort cervical proprioception postural control and pain unraveling the interconnected challenges in rheumatoid arthritis
topic Rheumatoid arthritis
Proprioception
Postural balance
Pain
Chronic pain
Proprioception
url https://doi.org/10.1186/s13018-025-05572-y
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