Associations of Disease Duration, Rheumatoid Factor, and Disease Activity with Hearing Loss in Patients with Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disease that may involve extra-articular organs, including the auditory system. This study investigated the associations of disease duration, rheumatoid factor (RF) status, and disease activity level with hearing loss in patients with RA at Adam Malik Hospital, Medan. This analytic observational study employed a cross-sectional design and was conducted at the Otorhinolaryngology and Internal Medicine outpatient clinics of Adam Malik General Hospital, Medan, from February 2025 to October 2025. The study population consisted of patients with rheumatoid arthritis (RA) diagnosed by a consultant rheumatologist. A total of 47 patients who met the inclusion and exclusion criteria were enrolled using a non-probability consecutive sampling technique. After obtaining informed consent, demographic and clinical data, including rheumatoid factor (RF) levels and DAS28-ESR scores, were obtained from interviews and medical records. Hearing function was assessed using tympanometry and pure-tone audiometry. The collected data were analyzed using univariate, bivariate, and receiver operating characteristic (ROC) analyses. Most patients were female (93.6%), with a mean age of 40.02 ± 6.75 years. The most frequent clinical characteristics were disease duration ≤5 years (53.2%), low disease activity (53.2%), and RF positivity (85.1%). Type A tympanograms predominated (93.6%). Mean hearing thresholds increased at higher frequencies, indicating predominant high-frequency involvement. Sensorineural hearing loss was the most common type, and the degree of hearing loss was generally mild to moderate. Disease duration, disease activity level, and RF status were significantly associated with the type of hearing loss (p < 0.005). Disease duration and RF status were significantly associated with the degree of hearing loss (p ≤ 0.005), whereas disease activity level was not (p ≥ 0.05). A disease duration of ≥5 years was associated with hearing loss. Patients with RA, particularly those with disease duration ≥5 years, RF positivity, or high disease activity, should be prioritized for periodic audiological screening to enable early detection of hearing loss.