HAND AND FOOT FUNCTION IN LATE-ONSET RHEUMATOID ARTHRITIS: CONFOUNDED BY MULTIPLE FACTORS RATHER THAN SOLELY BY DISEASE ACTIVITY

Hand and foot involvement is a major determinant of disability in patients with late-onset rheumatoid arthritis (LORA). While inflammatory disease activity has traditionally been regarded as the primary driver of functional impairment, increasing evidence indicates that hand and foot function in older patients is also influenced by additional factors. Age-related physiological changes, sarcopenia, structural joint damage, comorbidities, biomechanical alterations, and psychosocial factors may substantially contribute to functional decline, often independently of measurable inflammation. Elderly patients frequently experience reduced muscle strength, deformities, heightened pain, frailty, and impaired coping capacity, which together exacerbate limitations in daily activities and mobility. Although foot involvement has been less extensively studied than hand dysfunction, it contributes further to gait disturbance, pain, and reduced quality of life. This hypothesis article proposes that functional impairment in LORA is multifactorial rather than being driven solely by disease activity indices. Recognizing multiple determinants may help explain persistent disability despite controlled inflammation, justifying comprehensive functional and geriatric assessment strategies in LORA.