Artritis reumatoide: manifestaciones extraarticulares y comorbilidades

Abstract

IntroductionRheumatoid arthritis (RA) can present extra-articular manifestations (ExM) and comorbidities such as infections, cardiovascular events, and malignancies, which have been associated with increased morbidity and mortality. MethodologyAnalytical, observational, retrospective, 2012-2019. Extra-articular manifestations and comorbidities were studied in patients with established RA, attended in the EAS service of Maciel Hospital, in Montevideo, Uruguay. Results83 cases, mean age 59.1±11, 87% female sex. RA overlapping 30%, 84% of cases with positive RF, 73% with positive anti-CCP, seronegative RA 10.8%. Extra-articular manifestations: 38%, ILD was the most frequent. A higher proportion of those who developed extra-articular manifestations had RF and positive anti-CCP. Infections: observed in 55.4%, 41.3% serious, 95.7% were non-opportunistic infections. The most frequent were urinary and respiratory. The most common causal microorganism was Escherichia coli. Six patients with opportunistic infections were observed (pulmonary tuberculosis and herpes zoster). The use of corticosteroids was a risk factor for infections (OR: 3,974; 95%CI: 1.39-11.36; P=.008). SFZ was a protective factor (OR: .313; 95%CI: 0.104-.943; P=.033). Cardiovascular events: evidenced in 6 patients, 50% had high activity. No increased risk was found with the drugs received. Neoplasms: 5 cases were found, there was no significant association between the risk of malignancy and the drugs used. ConclusionsExtra-articular manifestations and comorbidities are frequent in RA patients, adding great morbidity. The risk of infections is multifactorial, influencing glucocorticoids and disease activity. Suspicion is important to carry out a search and timely treatment.