Patients with rheumatoid arthritis (RA) also suffer several comorbidities, the most common being circulatory and metabolic disorders, according to a Bangladesh study.
“Overall, we found a high burden of comorbidities among patients with RA, with circulatory and metabolic disorders, including obesity, dyslipidaemia, hypertension, and type 2 diabetes mellitus (T2DM), being the most prevalent,” the investigators said.
Of the 653 patients included in the analysis, 646 (98.9 percent) had at least one comorbidity. Dyslipidaemia (75.8 percent) was the most common comorbidity, followed by obesity (58.7 percent), hypertension (42.7 percent), T2DM (30.3 percent), and osteoporosis (15.6 percent). [J Rheumatol 2026;53:914-923]
RA patients aged ≥45 years had increased likelihood of developing coronary artery disease (odds ratio [OR], 9.71, 95 percent confidence interval [CI], 1.91‒178.00), osteoporosis (OR, 19.60, 95 percent CI, 5.96‒121.00), and infectious diseases (OR, 1.60, 95 percent CI, 1.03‒2.54).
Female patients with RA appeared to have a reduced cardiovascular risk (OR, 0.27, 95 percent CI, 0.11‒0.62), but they were more likely to develop osteoporosis (OR, 3.55, 95 percent CI, 1.71‒8.37) and gastrointestinal (GI) disorders (OR, 2.18, 95 percent CI, 1.37‒3.56).
Furthermore, the use of targeted synthetic (OR, 14.80) and biologic disease-modifying antirheumatic drugs (OR, 4.11) was associated with a higher risk of infection, while high Disease Activity Score in 28 joints (DAS28) and erythrocyte sedimentation rate (ESR) values correlated with GI comorbidities.
Notably, older patients (≥45 years) showed a significantly lower Charlson Comorbidity Index (CCI) score than their younger counterparts (mean 68.7 vs 93.3; p<0.001).
Implications
“The extremely high comorbidity burden observed in our study has important clinical implications,” the investigators said. “Patients with RA require a comprehensive assessment beyond joint inflammation, including regular screening for cardiovascular, metabolic, musculoskeletal, infection, and GI comorbidities.”
Such conditions must be identified and managed early to ease morbidity, improve treatment outcomes, and prevent long-term complications, according to the investigators, noting that multidisciplinary care involving rheumatologists, cardiologists, endocrinologists, and other specialists (eg, physiotherapists and nurse practitioners) may be necessary for the holistic care of RA patients.
Moreover, the inclusion of comorbidity monitoring in routine follow-up can guide individualized therapy and improve quality of life in patients.
“We recommend a comprehensive, individualized approach to managing RA, emphasizing early screening, targeted interventions, and multidisciplinary care to mitigate comorbidity-related complications and to improve long-term clinical outcomes in these patients,” the investigators said.
Study details
This cross-sectional study was conducted at two tertiary care hospitals in Bangladesh. The investigators obtained data on demographics, poor prognostic factors (high ESR, C-reactive protein, rheumatoid factor, anticyclic citrullinated peptide antibody titres, and DAS28 >5.1), and comorbidities using a structured questionnaire and medical record review.
The CCI was used to quantify comorbidities, while associated factors were identified through logistic regression analyses.
“RA is a chronic, systemic autoimmune disorder clinically characterized by persistent inflammation of the synovial membrane that gradually results in joint damage, structural deformities, and functional impairment,” the investigators said. [JAMA 2018;320:1360-1372; Autoimmun Rev 2021;20:102735]
“Beyond the musculoskeletal system, RA has significant extraarticular manifestations that affect multiple organ systems, including the cardiovascular, respiratory, and GI systems,” they added. [Autoimmun Rev 2021;20:102735]