The American Journal of Medical Sciences and Pharmaceutical Research
86
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TYPE
Original Research
PAGE NO.
86-88
10.37547/tajmspr/Volume07Issue01-12
OPEN ACCESS
SUBMITED
23 October 2024
ACCEPTED
25 December 2024
PUBLISHED
30 January 2025
VOLUME
Vol.07 Issue01 2025
CITATION
Sadikova S.I., & Umarova G.K. (2025). Currency and diagnostic criteria of
rheumatoid arthritis in patients of senior age groups. The American Journal
of Medical Sciences and Pharmaceutical Research, 7(01), 86
–
88.
https://doi.org/10.37547/tajmspr/Volume07Issue01-12
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Currency and diagnostic
criteria of rheumatoid
arthritis in patients of
senior age groups
Sadikova S.I.
Tashkent Medical Academy, Uzbekistan, Tashkent
Umarova G.K.
Akfa University Clinic “Akfa medline”, Uzbekistan, Tashkent
Abstract:
This article presents the results of the study of
the peculiarities of the course and diagnosis of
rheumatoid arthritis (RA) in elderly people. In our work
we studied 56 RA patients. Of these, 25 (44.6%) of the
patients first fell ill in old age, 16 (28.5%) of patients
became ill for more than 15 years and 15 (26.7%) of
patients younger than 45 years made up a control group.
Keywords:
Rheumatoid arthritis, elderly age.
Introduction:
According to various research groups,
rheumatoid arthritis (RA) affects 0.5-2.5% of the adult
population [3,6]. RA can occur in childhood (juvenile
RA), but most often the age of onset is the age of onset
of the disease is 52±15 years. Among people under 35
years of age, the prevalence of RA is 0.38%, and in
people over 55 years of age - 1.4%. Women are more
likely to get sick than men - 2-3:1 [2]. A high incidence
of RA is noted in first-degree relatives (3.5%), especially
in females (5.1%). The last two decades have seen
significant advances in the study of the pathophysiology
and treatment of rheumatoid arthritis. The aphorism
that was widely used in the 1960s-
80s was: “We don't
treat RA, we manage the patient with the disease"
–
today can be considered an anachronism [4].
Timely administration (i.e., at the early stages of the
disease, ideally in the first three months) of disease-
modifying antirheumatic drugs (DMARDs) in adequate
doses independently, and if necessary, in various
combinations, allows in many cases to successfully
control the activity of the disease, prevent or slow down
the development of erosive processes [5]. A major
achievement was the creation and introduction into
clinical practice of RA treatment of so-called biological
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The American Journal of Medical Sciences and Pharmaceutical Research
agents of medical preparations obtained by genetic
engineering, the targets of which are key
proinflammatory cytokines, their receptors and
immunocompetent cells.
The results of a number of studies allow us to look with
optimism at the possibilities of low doses of
glucocorticoids (GC) both in controlling the activity of
the disease and in slowing the progression of joint
lesions. In old age, according to some data, the onset
of RA is often characterized by a low degree of activity
of the inflammatory process, which, when assessed
retrospectively, is classified as a “chronic” course of
the disease.”
In such cases, the signs of articular syndrome develop
gradually over several months [8]. Extra-articular
manifestations of the disease are observed in no more
than 20% of cases. In approximately 2/3 of elderly
patients, RA begins with symmetrical oligoarthritis, in
1/3 with symmetrical polyarthritis. Damage to large
joints at the onset of the disease is observed in 30% of
cases. According to other authors, the onset of
rheumatoid arthritis in elderly individuals is more
acute, with virtually no prodrome.
There is a predominant lesion of large joints rather
than small joints of the hands and feet. There is a
leveling in the sex ratio: the ratio of men to women is
1:1, while at a younger age, women predominate.
Identification of new inflammation markers, the use of
ultrasound and magnetic resonance imaging (MRI)
have significantly improved the diagnosis of RA and
dynamic monitoring of the effectiveness of therapy
[1,4].
Rheumatoid arthritis is of particularly great medical
and social significance. At the same time, the economic
losses from rheumatoid arthritis for society are
comparable to ischemic heart disease.
The significant prevalence of RA, mainly among the
working-age population, leads to the chronicity of the
disease and its progressive course, high frequency of
loss of professional ability of patients. The process of
human aging is accompanied by changes in the genetic
apparatus of the cell, the development of a number of
diseases. The increase in the number of elderly and
senile people observed in Uzbekistan, as in many other
countries, is accompanied by an increase in the
number of diseases associated with the aging process
- osteoarthritis, rheumatoid arthritis, osteoporosis,
diabetes, obesity, Alzheimer's disease [5].
The problem of studying rheumatoid arthritis in old
age remains one of the most pressing in rheumatology.
Rheumatoid arthritis is the most common form of joint
pathology, one of the main causes of chronic pain
syndrome, premature loss of ability to work and
disability. In the prevention of rheumatological
diseases, including rheumatoid arthritis in the elderly, it
allows normalizing bone remodeling processes,
improving its strength characteristics, reducing the risk
of fractures, and improving the quality of life.
The social significance of RA is determined not only by
its widespread prevalence, but above all by the fact that
it quickly leads to disability of patients, with the ensuing
consequences: a change in the quality of life and great
material damage caused to both the patient and the
patient himself.
both the patient and society [7].
Objective of the research work to study of diagnostic
criteria of RA in elderly people.
METHODS
The observation included 56 patients who came to the
Akfa University Clinic “Akfa medline ”, for 2018
-2020, of
which 25 (44.6%) patients who first became ill at an
elderly age, 16 (28.5%) patients with a disease history of
more than 15 years and 15 (26.7%) patients were under
45 years old, who constituted the control group.
The diagnosis of RA was carried out according to the
criteria of experts of the American College of
Rheumatology and the European League Against
Rheumatism (ACR/EULAR RA) 2010 and taking into
account the additions made by the staff Institute of
Rheumatology of the Russian Academy of Medical
Sciences. Of the total number of RA patients who first
developed the disease in old age, there were 14 men
(21.2%) and 52 women (78.8%); the ratio of males to
females was 1:4.
There were 38 (57.5%) patients over 60 years of age.
Among the RA patients we examined, 68.5% had a
disease history of up to 6 years, which allowed us to
carefully analyze the dynamics of clinical manifestations
and the reason for their progression from the very
beginning of the disease.
Based on the conducted research, the following were
determined:
- seropositivity for rheumatoid factor (RF);
- the nature of the course of RA according to G.P.
Matveykov and V.E. Yagur;
- the degree of RA activity according to the criteria of V.
Otto and M.G. Astapenko;
- the degree of functional insufficiency of the joints;
-
radiological stage of RA according to O. Steinbroker’s
criteria;
- the presence of extra-articular manifestations of the
disease.
RESULTS AND DISCUSSION
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The American Journal of Medical Sciences and Pharmaceutical Research
As a result of the conducted studies, it was established
that the clinical features of the course of RA that began
in old age are frequent lesions of large and medium
joints at the onset of the disease (63.6%), in contrast to
the classical variant of RA. In 52.2% of cases of RA in
the elderly, it began acutely or subacutely with
increasing signs of joint inflammation. Depending on
the presence of rheumatoid factor in the blood serum,
patients were divided into 2 groups: with a titer of 1:32
and above, RA was assessed as seropositive, and with
a titer below 1:32 - as seronegative. 67% of the
patients examined by us had seropositive RA. The
study of the clinical picture of the disease showed that
89% of patients with RA that began in old age had
stages II and III of the inflammatory process activities.
Radiological manifestations of stage I were detected in
2.5% of patients, II
–
in 55.5%, III
–
in 31.4%, IV
–
in
10.6% of patients.
In rheumatoid arthritis, loss of professional ability and
disability contribute to the development of severe joint
failure (SJF), the cause of which is the progression of
bone destruction. SJF Grade I was observed in 20.4% of
patients, grade II
–
in
53%, III degree
–
in 28.9%.
The study of the joint syndrome showed that patients
with RA had reliably high values of the Ritchie index of
19.1±1.1 points, the number of inflamed joints of
5.1±3.1, pain at rest - VAS 42.1±18.3, pain during
movement according to VAS 65.7±18.5, pain during
palpation - VAS 39.4±19.7.
The duration of morning stiffness in elderly RA patients
was significantly shorter (p<0.005) than in the control
group.
In the elderly, at the onset of the disease, an important
diagnostic sign, “morning stiffness,” appears after 3
-4
months and even a year from the onset diseases. In
elderly patients with RA, in addition to joint
manifestations, it also occurs with damage to internal
organs. Visceral lesions were diagnosed in 35 (53%)
patients, manifested as vasculitis in 15 (22.7%),
Raynaud's syndrome in 5 (7.5%), rheumatoid nodules
in 7 (10.6%); other manifestations of the disease were
noted in 4 (6%) patients.
The clinical course of RA in the elderly is characterized
by frequent lesions of large and medium joints, acute
and subacute onset of the disease, high activity of the
inflammatory process, severe joint syndrome, rapid
formation of bone-cartilage destruction, a sharp
restriction of motor activity, leading to early loss of
ability to work and disability, involvement of internal
organs in the pathological process.
Thus, rheumatoid arthritis in the elderly particularly
affects large and medium joints that perform the main
musculoskeletal function, which leads to a limitation of
physical activity in patients and contributes to the
development of disability and the rapid development of
trophic disorders in many patients.
The pronounced activity of the inflammatory process,
the rapid development of osteochondral destruction,
and the low effectiveness of NSAIDs make it necessary
to prescribe glucocorticosteroids to elderly patients
with RA in the early stages of the disease, not only intra-
articularly, but also orally in small doses.
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