OBJECTIVE: to elaborate recommendations of the Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology (SBR) to manage comorbidities in rheumatoid arthritis (RA). METHODS: to review the literature and the opinions of the SBR RA Committee experts. RESULTS AND CONCLUSIONS: Recommendations: (1) early diagnosis and proper treatment of comorbidities are recommended; (2) the specific treatment of RA should be adapted to the presence of comorbidities; (3) Angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers are preferred to treat systemic arterial hypertension; (4) in patients diagnosed with rheumatoid arthritis and diabetes mellitus, the continuous use of a high cumulative dose of corticoids should be avoided; (5) Statins should be used to maintain LDL cholesterol levels under 100 mg/dL and the atherosclerotic index lower than 3.5 in patients with RA who have other comorbidities; (6) metabolic syndrome should be treated; (7) performing non-invasive tests to investigate subclinical atherosclerosis is recommended; (8) greater surveillance for the early diagnosis of occult malignancy is recommended; (9) preventive measures of venous thrombosis are suggested; (10) bone densitometry is recommended in RA patients over the age of 50 years and in younger patients on corticoid therapy at a dose greater than 7.5 mg for over three months; (11) patients with RA and osteoporosis should be instructed to avoid falls, to increase their dietary calcium intake and sun exposure, and to exercise; (12) calcium and vitamin D supplementation is suggested. Bisphosphonates are suggested for patients with T score < -2.5 on bone densitometry; (13) a multidisciplinary team, with the active participation of a rheumatologist, is recommended to treat comorbidities.

Full text (sometimes free) may be available at these link(s):      help

• DOI
• PubMed
• PDF locator
• publisher

Additional document(s) available for this guideline:

• alternate full version (in Portuguese)