Spectrum of Comorbidities and Their Association with Disease Activity in Patients with Rheumatoid Arthritis

Abstract

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis affecting 0.5-1% of adults worldwide, with significant functional disability and economic burden. Comorbidities in RA are increasingly recognized as important determinants of disease outcomes, yet data on their spectrum and association with disease activity in Bangladesh is limited.

Objective: To identify the spectrum of comorbidities and their relationship with disease activity in patients with rheumatoid arthritis attending a tertiary care hospital in Bangladesh.

Methods: This observational study with analytical component was conducted at the Department of Rheumatology, Bangladesh Medical University (BMU), Dhaka, Bangladesh. A total of 368 RA patients aged ≥18 years diagnosed according to ACR/EULAR 2010 criteria were enrolled. Disease activity was measured using Clinical Disease Activity Index (CDAI). Comorbidities including hypertension, diabetes mellitus, hypothyroidism, dyslipidemia, chronic kidney disease, coronary artery disease, asthma, COPD, and osteoporosis were documented. Data were analyzed using SPSS version 25.0 with unpaired t-test, chi-square test, and Fisher's exact test.

Results: The prevalence of most were female (83.2%, female: male ratio 4.9:1), with a mean age of 42±11 years. Most had moderate (41.3%) and high (42.1%) disease activity. Comorbidities were present in 186 patients (50.5%), mainly hypertension (20.7%), diabetes mellitus (9.2%), hypothyroidism (9.0%), and asthma (6.0%). Diabetes (p=0.02), dyslipidemia (p=0.04), and hypothyroidism (p=0.02) were associated to higher CDAI scores. Methotrexate was used in 86.1%, and tofacitinib in 6.8%.

Conclusion: Rheumatoid arthritis predominantly affects middle-aged females with moderate-to-high disease activity in Bangladesh. Comorbidities are highly prevalent and significantly associated with higher disease activity. Routine screening and integrated management of comorbidities are therefore essential to optimize disease control and improve overall outcomes in patients with rheumatoid arthritis

Bangladesh J Medicine 2026; 37(3): 219-226