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Correlation of Serological Status with Disease Activity Score 28-Erythrocyte Sedimentation Rate Score in Elderly
Shubhangi Kanitkar1, M Sai Rohith Reddy, Nimmagadda Panindra
1Department of General Medicine, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, (Deemed to be University), Pune, Maharashtra, India.
Background:
Rheumatoid arthritis (RA) in the elderly is a clinically distinct entity with unique presenting features, serological profiles, and high disease burden. Elderly-onset RA (EORA), defined as RA with onset at or after 65 years, remains understudied in the Indian population despite its growing prevalence.
Objective:
To characterize the clinical profile of elderly RA patients and to evaluate the correlation between serological status and disease activity as measured by disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR).
Methodology:
A cross-sectional observational study was conducted at a tertiary care centre enrolling 120 elderly patients (aged ≥60 years) diagnosed with RA by ACR/EULAR 2010 criteria. Clinical, laboratory, serological, and disease activity parameters were systematically recorded.
Results:
The mean age was 67.53 ± 6.047 years; 66.7% were female. Classical RA was the most common clinical form (70%), followed by polymyalgia rheumatica-like (25%) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE)-like (5%), with a significant association between the RS3PE-like form and advancing age (P = 0.005). Acute onset was observed in 70%. The shoulder was the most commonly involved joint (43.3%). Proximal interphalangeal joint involvement was significantly higher in YORA (37.9% vs. 14.8%; P = 0.007), whereas ankle joint involvement was significantly higher in EORA (27.8% vs. 7.6%; P = 0.006). Asymmetric joint involvement was significantly more common in EORA (66.7% vs. 42.4%; P = 0.010). RF positivity was 71.7%, anti-cyclic citrullinated peptide (CCP) 69.2%, and overall seropositivity 78.3%. Anti-CCP positivity was significantly associated with high disease activity (P = 0.020), and overall seropositivity was significantly associated with disease activity category (P = 0.033). Mean ESR was 56.41 ± 20.369 mm/h, C-reactive protein was 38.97 ± 19.467 mg/L, and hemoglobin was 11.86 ± 1.246 g/dL. The mean DAS28-ESR was 5.28 ± 0.857; 63.3% had high, and 34.2% had moderate disease activity. Hypertension (30%) and diabetes mellitus (18.3%) were the most prevalent comorbidities. Only 34.2% were on disease-modifying antirheumatic drugs (DMARDs) at enrollment.
Conclusion:
RA in the Indian elderly population is characterized by acute onset, large joint involvement, high serological positivity, elevated inflammatory markers, and predominantly high disease activity. Anti-CCP positivity is a significant predictor of high disease activity. The high comorbidity burden and suboptimal DMARD utilization underscore the need for early diagnosis and comprehensive multidisciplinary management.
