Prevalence of Comorbidities and Poor Prognostic Factors Among Patients with Rheumatoid Arthritis in Bangladesh

OBJECTIVE: This study aimed to assess the prevalence of comorbidities among Rheumatoid arthritis (RA) patients and identify factors associated with it. METHODS: A cross-sectional study was conducted at 2-tertiary care hospitals among 653 patients with RA. Data on demographics, poor prognostic factors (high ESR, CRP, RF, anti-CCP antibody titres, and DAS28 > 5.1); and comorbidities were collected via a structured questionnaire and medical record review. Comorbidities were quantified via the Charlson Comorbidity Index (CCI). Logistic regressions were used to identify associated factors. RESULTS: A total of 643 (98.5%) patients had ≥1 comorbidity. The most prevalent were dyslipidemia (75.8%), obesity (58.7%), hypertension (42.7%), type 2 diabetes (30.3%), and osteoporosis (15.6%). Age ≥ 45 years was independently associated with coronary artery disease (OR 9.71, 95% CI 1.91-178.00), osteoporosis (OR 19.60, 95% CI 5.96-121.00) and infectious diseases (OR 1.6, 95% CI 1.03- 2.54). Male sex was associated with increased cardiovascular risk (female OR 0.27, 95% CI 0.11-0.62), whereas female sex was associated with increased odds of osteoporosis (OR 3.55, 95% CI 1.71-8.37) and gastrointestinal disorders (OR 2.18, 95% CI 1.37-3.56). The use of tsDMARDs and bDMARDs increased the risk of infection (ORs of 14.80 and 4.11, respectively). High DAS28-CRP and ESR values were linked to gastrointestinal comorbidities. The CCI survival index was significantly lower in older patients (≥45 years) (mean 68.7, SD 26.7) than in younger patients (mean 93.3, SD 6.7, p < 0.001). CONCLUSION: Patients with RA in Bangladesh have high multimorbidity, particularly early CVD risk.