Co esponding au ho : Ga ba Ha ine Abdel Aziz
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Elde ly-onse heuma oid a h i is in Chad: A se ies o 10 hospi al cases
Ha ine Abdel Aziz Ga ba 1, *, Adama Bah 2, Bouch ane Ramadhane 4, Ha ine Abdel Aziz Hamid 1, Mous apha
Niasse 3 and Saïdou Diallo 3
1 Depa men o Rheuma ology, CHURN – Uni e si y o N'Djamena, N'Djamena, Chad.
2 Depa men o Rheuma ology, Ignace Deen Uni e si y Hospi al – Gamal Abdel Nasse Uni e si y, Conak y, Guinea.
3 Rheuma ology Uni , Na ional Cen e o O hopedic Fi ing (CNAO), Daka – Cheikh An a Diop Uni e si y, Daka , Senegal.
4 Depa men o Rheuma ology, Coud Hospi al – Cheikh An a Diop Uni e si y, Daka , Senegal.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1632-1638
Publica ion his o y: Recei ed on 15 July 2025; e ised on 20 Augus 2025; accep ed on 23 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.3033
Abs ac
Objec i e. To desc ibe he clinical, labo a o y, como bid and he apeu ic ea u es o elde ly-onse heuma oid a h i is
(EORA) in Chad.
Me hods. A e ospec i e single-cen e s udy was conduc ed in he Rheuma ology Depa men o CHURN, N’Djamena,
be ween Janua y 2019 and Decembe 2024. Pa ien s ul illing he 2010 ACR/EULAR c i e ia o RA wi h symp om onse
≥60 yea s we e included. Demog aphic, clinical, labo a o y, como bidi y, ea men , HAQ and DAS28-CRP da a we e
collec ed and analyzed.
Resul s. Ten pa ien s we e included (mean age 68 ± 4 yea s; 60% emale). Rhizomelic onse was obse ed in 70% o
cases. Rheuma oid ac o was posi i e in 8/10 pa ien s and an i-CCP an ibodies in 9/10. The main como bidi ies we e
os eopo osis (60%), hype ension (30%) and diabe es (20%). Me ho exa e was p esc ibed in 80% and co icos e oids
in 70% o pa ien s. Mean HAQ sco e was 25/60 and mean DAS28-CRP was 4.2.
Conclusion. Elde ly-onse RA in Chad is cha ac e ized by equen hizomelic onse , high se ological posi i i y, common
como bidi ies and signi ican unc ional impai men . These indings highligh he need o indi idualized managemen
and imp o ed access o disease-modi ying he apies.
Keywo ds: Rheuma oid A h i is; Elde ly-Onse ; An i-CCP; Me ho exa e; Como bidi ies; Chad
1. In oduc ion
Rheuma oid a h i is (RA) is a ch onic, sys emic, au oimmune in lamma o y disease cha ac e ized by des uc i e
polya h i is and majo unc ional impai men . Al hough peak incidence occu s be ween 40 and 60 yea s, a subs an ial
p opo ion o cases a ise a e he age o 60. yea s [1].This condi ion is e med elde ly-onse heuma oid a h i is
(EORA).
EORA exhibi s dis inc clinical and biological ea u es. Onse is equen ly ab up and hizomelic, o en associa ed wi h
sys emic mani es a ions. An i-CCP an ibodies and heuma oid ac o emain aluable diagnos ic ools, al hough hei
exp ession a ies ac oss popula ions. Como bidi ies (os eopo osis, diabe es, hype ension) a e common and
complica e he apeu ic managemen , limi ing he use o ce ain ea men s, pa icula ly biologics agen . [2,4].
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In sub-Saha an A ica, da a on EORA emain sca ce. A ew se ies om Senegal,[2]. Guinea, [1].Togo, [3]. and Benin[4].
ha e highligh ed an inc easing equency o his o m as li e expec ancy ises. Howe e , in Chad, no dedica ed s udy has
been epo ed o da e.
1.1. Objec i e
The aim o his s udy was o desc ibe he clinical, labo a o y, como bid, and he apeu ic ea u es o EORA in a
heuma ology depa men in Chad.
2. Pa ien s and Me hods
2.1. S udy design and se ing
This was a e ospec i e, desc ip i e and analy ical s udy conduc ed in he Rheuma ology Depa men o he Uni e si y
Teaching Hospi al o Na ional Re e ence (CHURN) in N’Djamena, Chad.
2.2. S udy pe iod
Da a collec ion co e ed a 5-yea pe iod, om Janua y 2019 o Decembe 2024.
2.3. S udy popula ion
All pa ien s diagnosed wi h heuma oid a h i is (RA) acco ding o he 2010 ACR/EULAR classi ica ion c i e ia, wi h
symp om onse a ≥60 yea s o age, we e included.
2.3.1. Exclusion c i e ia
Excluded we e:
• pa ien s wi h o he connec i e issue diseases (lupus, scle ode ma, isola ed Sjög en’s synd ome, e c.),pa ien s
wi h incomple e medical eco ds,and hose whose symp om onse occu ed be o e he age o 60.
• Collec ed a iables. Da a included:
• sociodemog aphic cha ac e is ics: age, sex;
• clinical aspec s: onse ype, ende and swollen join coun , sys emic ea u es;
• labo a o y and imaging da a: e y h ocy e sedimen a ion a e (ESR), C- eac i e p o ein (CRP), heuma oid
ac o (RF), an i-CCP an ibodies, plain adiog aphs;
• como bidi ies: os eopo osis, diabe es, hype ension, o he ch onic condi ions;
• ea men s ecei ed: co icos e oids, me ho exa e, o he con en ional DMARDs;
• unc ional and disease ac i i y assessmen : Heal h Assessmen Ques ionnai e (HAQ), Disease Ac i i y Sco e
(DAS28-CRP).
2.4. S a is ical analysis
Da a we e en e ed and analyzed using a s anda d s a is ical so wa e (Excel® 2019). Resul s a e exp essed as mean ±
s anda d de ia ion (SD) o quan i a i e a iables and as absolu e and ela i e equencies (%) o quali a i e a iables.
2.5. E hical conside a ions
The s udy was conduc ed in compliance wi h pa ien da a con iden iali y. Au ho iza ion om he Head o he
Rheuma ology Depa men a CHURN was ob ained p io o da a collec ion.
3. Resul
3.1. Epidemiological and clinical ea u es
Ten pa ien s we e included. The mean age was 68 ± 4 yea s ( ange: 62–76 yea s). Mos pa ien s we e emale (6 women,
4 men; M/F sex a io = 0.6). The onse was ab up and hizomelic in 7 cases (70%). The median ende join coun was
7 [3–18], and he median swollen join coun was 3 [0–7]. Th ee pa ien s (30%) p esen ed sys emic signs ( e e , a igue,
weigh loss). (Table 1)
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Labo a o y and adiological indings. In lamma o y synd ome (ESR, CRP) was p esen in all pa ien s. Rheuma oid ac o
was posi i e in 8 ou o 10 cases, and an i-CCP an ibodies in 9 cases. S anda d adiog aphs e ealed ea ly e osions in 4
cases. (Table 2)
3.2. Como bidi ies.
Como bidi ies we e equen : os eopo osis in 6 cases (60%), hype ension in 3 cases (30%), and diabe es in 2 cases
(20%).
3.3. T ea men .
Me ho exa e was p esc ibed in 8 pa ien s (80%), co icos e oids in 7 pa ien s (70%), and a combina ion o
con en ional DMARDs (le lunomide o sul asalazine) in 3 pa ien s (30%). None o he pa ien s had access o biologic
he apies.
3.4. Func ional assessmen and disease ac i i y.
The mean HAQ sco e was 25/60, indica ing mode a e o se e e unc ional impai men . (Table 3). The mean DAS28-CRP
sco e was 4.2, consis en wi h mode a e disease ac i i y. The dis ibu ion o DAS28 sco es is shown in Figu e 1.
Table 1 Epidemiological and clinical cha ac e is ics (n = 10)
Va iables
Résul a s
Nomb e de cas
10 (14 % des PR)
Âge moyen (ans)
68 ± 4 (62–76)
Sexe a io (H/F)
0,6 (6F/4H)
A icula ions doulou euses (moyenne)
7 (3–18)
A icula ions gon lées (moyenne)
3 (0–7)
Fiè e + al é a ion é a géné al
3 cas (30 %)
Débu hizomélique
7 cas (70 %)
Table 2 Biological da a, como bidi ies and he apeu ics (n = 10)
Va iables
Résul a s
Synd ome in lamma oi e
10/10
FR posi i s
8/10
An i-CCP posi i s
9/10
Os éopo ose
6/10
Hype ension a é ielle
3/10
Diabè e
2/10
Mé ho exa e
8 cas
Co ico hé apie
7 cas
Au es DMARDs (asso.)
3 cas
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Table 3 Func ional assessmen and disease ac i i y(n = 10)
Sco es
Résul a s
HAQ (moyen)
25/60
SF-36
Non éalisé
NHP
Non éalisé
Figu e 1 Dis ibu ion o DAS28-CRP
4. Discussion
Elde ly-onse heuma oid a h i is (EORA) is a dis inc en i y, di e ing om younge -onse RA by i s clinical
p esen a ion, associa ed como bidi ies, and he apeu ic challenges. In ou se ies, he mean age was 68 yea s, which is
compa able o indings om Wes A ica whe e he mean diagnos ic age anges be ween 65 and 70 yea s [ 1-3,5]. The
emale p edominance (60%) is consis en wi h in e na ional da a,[6], al hough some A ican s udies epo a mo e
balanced sex a io. [7,8].
Clinically, hizomelic onse was obse ed in 70% o ou pa ien s, con i ming da a om Senegal and Guinea whe e his
p esen a ion anges be ween 50% and 65%. This ab up onse wi h sys emic ea u es may mimic polymyalgia
heuma ica, leading o diagnos ic delay. [9]. Simila indings ha e been epo ed in F ance, whe e elde ly-onse RA is
ecognized as a dis inc subg oup wi h speci ic he apeu ic challenges [6]. In Wes A ica, long- e m se ies om Bu kina
Faso also highligh ed he ising bu den o ch onic in lamma o y heuma ism in he elde ly [7]. P edic i e ac o s o
e osi e disease in elde ly RA we e simila ly no ed in I o y Coas [8]. His o ical e iews con i med he unde - ecogni ion
o elde ly RA in sub-Saha an A ica [9].
F om a labo a o y pe spec i e, high posi i i y a es o an i-CCP an ibodies (90%) and heuma oid ac o (80%) we e
no ed, in line wi h in e na ional epo s, [10–13], highligh ing he diagnos ic u ili y o se ology in EORA. Howe e , lowe
se oposi i i y a es ha e been epo ed in some Togolese and Beninese s udies, [3,4,14], likely due o me hodological
a ia ions and limi ed access o labo a o y assays.
The i s documen ed cases om Nige also illus a e he diagnos ic challenges o RA in A ica [10]. In e na ional da a
emphasize he complexi y o managing RA in he elde ly due o como bidi ies and d ug ole ance [11,12]. Quali y o li e
impai men in elde ly RA has also been unde lined in s udies om Guinea and Came oon [13]
Como bidi ies we e equen in ou coho , pa icula ly os eopo osis (60%), hype ension (30%), and diabe es (20%).
These indings unde sco e he hea y bu den o ch onic condi ions in elde ly pa ien s and hei impac on managemen
[15–17]. Pa icula i ies o male RA in elde ly pa ien s we e epo ed in Bu kina Faso [16]. Popula ion-based US s udies
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1632-1638
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con i m he high p e alence o RA in pe sons o e 60 yea s o age [17]. In sub-Saha an A ica, os eopo osis is o
pa icula conce n due o limi ed a ailabili y o bone densi ome y and speci ic ea men s.[18,19]. Me ho exa e
ole ance in elde ly RA has also been e alua ed in Benin, showing simila sa e y issues [18]. The in oduc ion o biologics
in Gabon emains limi ed o a ew pilo expe iences [19].
The apeu ically, me ho exa e emained he co ne s one, p esc ibed in 80% o cases, o en combined wi h
co icos e oids. The lack o access o biologic he apies is a majo limi a ion in ou se ing, whe eas such agen s ha e
demons a ed e icacy in EORA in high-income coun ies. [20–27].
The concep o elde ly-onse RA was i s well desc ibed in seminal s udies in he 1990s [20]. Immunogene ic s udies
sugges o e laps be ween elde ly-onse RA and polymyalgia heuma ica [21]. Age a onse may in luence pheno ype
and p ognosis, as demons a ed in B i ish coho s [22]. Spanish s udies ha e also con i med speci ic ou comes in la e-
onse RA [23]. Upda ed UK p e alence da a ein o ce he g owing ecogni ion o elde ly RA [24]. In Ko ea, s udies
highligh ed d ug e en ion and sa e y o TNF inhibi o s in elde ly RA pa ien s [25]. Re iews on DMARD use in he elde ly
popula ion unde line speci ic he apeu ic challenges [26]. Guidelines ecommend me ho exa e as he co ne s one o
he apy, including in elde ly pa ien s [27].
4.1. S udy limi a ions
This s udy has some limi a ions: small sample size (10 cases), e ospec i e and single-cen e design, and absence o
long- e m ollow-up. Ne e heless, i ep esen s he i s Chadian se ies ocused on EORA and p o ides no el da a in
he A ican con ex .
4.2. Implica ions
Ou indings highligh he need o inc eased awa eness o EORA, sys ema ic sc eening o como bidi ies, and ad ocacy
o imp o ed access o mode n disease-modi ying he apies in Chad.
5. Conclusion
Elde ly-onse heuma oid a h i is in Chad is cha ac e ized by equen hizomelic onse , high se ological posi i i y,
and a high bu den o como bidi ies, pa icula ly os eopo osis, hype ension, and diabe es. These ac o s complica e
managemen and con ibu e o signi ican unc ional impai men .
Al hough limi ed by i s small sample size and single-cen e design, his s udy ep esen s he i s Chadian se ies
dedica ed o his opic. I highligh s he need o ea ly diagnosis, sys ema ic como bidi y sc eening, and b oade access
o disease-modi ying d ugs, including biologics.
Looking o wa d, be e o ganiza ion o heuma ology ollow-up and ad ocacy o he a ailabili y o mode n he apies
could imp o e he quali y o li e o elde ly pa ien s wi h RA in Chad.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
The au ho s decla e ha hey ha e no con lic o in e es ega ding his wo k.
Au ho s’ con ibu ion
All au ho s con ibu ed equally o he design, da a collec ion, analysis, and w i ing o he manusc ip .
S a emen o e hical app o al
The s udy was conduc ed in acco dance wi h e hical p inciples and was app o ed by he local e hics commi ee.
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