Study of Rheumatoid Arthritis in older patients: A cross-sectional study

Background: Rheumatoid Arthritis (RA) is a common chronic inflammatory arthritis causing severe disability and impacting patients' physical, psychological, and social health, as well as society due to healthcare costs and decreased productivity. This study analyzes RA in older patients focusing on clinical, radiological, immunological profiles, disease activity, severity, disability, comorbidities, and the diagnostic utility of a new serum marker, 14-3-3η. Methodology: A cross-sectional study recruited 200 arthritis patients over sixty years old and 40 controls. Anti-CCP and serum 14-3-3η levels were measured. Descriptive analysis was performed for all variables. Quantitative variables were compared using unpaired t-test or Wilcoxon Rank Sum test, and categorical variables using Chi-Square or Fisher exact test. Spearman’s correlation coefficient assessed associations between continuous variables. ROC curves determined optimal cut-off values for serum ACCP and 14-3-3η levels. Results: The most common complaints were joint pain (100% small and large joints, 31.7%), fatigue (71.4%), myalgia (61.4%), fever (55.56%), weight loss (46.03%), neuropathy (25.4%), and PMR-like symptoms (19.05%). Impaired ADL and IADL were noted in 17.5% and 73.2%, respectively. Impaired HMSE and GDS were found in 36.5% and 41.2%, respectively. The mean age of RA onset was 55.8 years, and the mean RA duration was 7.8 years. The mean number of joints involved was 3.6, and EMS was 28.8 minutes. TJC and SJC means were 8.6 and 2.17, respectively. The mean VAS, CRP, ESR, DAS28ESR, and DAS28CRP were 39, 6.9, 33.3, 6.12, and 2.2, respectively. Serum ACCP and 14-3-3η means were 4.4 and 2.2, respectively. Common deformities were swan neck (30.19%), ulnar deviation (20.63%), and boutonniere (19.05%). For ACCP, a cut-off value of ≥ 0.5098 U/mL had 77.7% sensitivity and 76.64% specificity. For 14-3-3η, a cut-off value of ≥ 1.471 U/mL had 55.56% sensitivity and 54.74% specificity. Using both markers, 88.88% of RA patients were positive for one of the tests. Conclusion: RA is prevalent in the elderly, especially in women, and is associated with impaired CGA scores and comorbidities like hypothyroidism and osteoporosis. PMR-like symptoms are common, indicating an acute onset and severe course. DMARDS remain the main treatment. Plasma 14-3-3η is a useful diagnostic marker, especially when combined with ACCP, warranting further investigation for early RA diagnosis.