Study of rheumatoid arthritis in older patients: a cross-sectional study

Rheumatoid Arthritis (RA) in older adults is a chronic inflammatory condition causing severe disability and impacting patients' physical, psychological, and social health. It lowers productivity in society and puts pressure on healthcare systems. This study aims to explore the different aspects of RA and investigate the diagnostic potential of serum marker 14-3-3η.

This Cross-sectional study recruited 205 arthritis patients (63 RA and 142 OA) over sixty years old. The participants underwent a thorough clinical evaluation according to the established design. Anti-CCP and serum 14-3-3η levels were measured. Simple logistic regression was performed to identify significant predictors of RA. ROC curve determined optimal cut-off value for 14-3-3η.

This study reported an average age of 63.67 years with a high female-to-male ratio of 4:1 in the RA cohort, while in the OA cohort, the mean age was 65.5 years with a low female-to-male ratio of 2:1 overall. Symptomatically, RA patients exhibited earlier onset, pronounced early morning stiffness, fever, weight loss, myalgia, and fatigue, all with highly significant p-values (< 0.001). Comorbidities showed higher incidences of anemia, ILD, and osteoporosis in RA patients. Impaired ADL and IADL were noted in 17.5% and 73.2%, respectively. Impaired HMSE and GDS were found in 36.5% and 74.6%, respectively. Logistic regression analysis identified key predictors distinguishing RA from OA, including EMS (OR: 1.09, p < 0.001), fever (OR: 6.68, p < 0.001), weight loss (OR: 6.35, p < 0.001), myalgia (OR: 5.07, p < 0.001), osteoporosis (OR: 2.21, p = 0.013), ACCP levels (OR: 1.28, p < 0.001), and the novel marker 14-3-3η (OR: 2.87, p = 0.047). Using both ACCP and14-3-3η markers, 88.88% of RA patients were positive for at least one marker, enhancing its diagnostic coverage. Elderly onset RA (EORA) patients had a significantly higher age and shorter disease duration compared to those with young onset RA (YORA). The female-to-male ratio in the YORA and EORA group were 6.97:1 and 1.66:1 respectively. PMR-like symptoms were more prevalent in the EORA group (31.25% vs.14.9%). Hypothyroidism was more frequent in the EORA group (31% vs. 17%). Sulfasalazine was more commonly prescribed in both EORA (100%) and YORA (89%) groups.

This study contributes to a better understanding of distinguishing RA from OA. It also highlights the differences between young and elderly onset RA, and supports the diagnostic potential of the serum marker 14-3-3η.