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BackgroundPatients with rheumatoid arthritis (RA) are at increased risk to develop comorbidities. Data on the prevalence of comorbidities in RA patients in South-Africa is lacking.1 Poorly controlled joint inflammation, common use of glucocosteroids and nonsteroidal anti-inflammatory drugs, a high prevalence of smoking and obesity, together with a high burden of infectious diseases may be important risk factors for comorbidities in this population.ObjectivesTo assess the prevalence of comorbidities in RA patients in Cape Town, South-Africa and the association with disease activity and DMARD use using the METEOR (Measurement of Efficacy of Treatment in the ‘Era of Outcome’ in Rheumatology) database.MethodsThis is an ongoing cross-sectional study. Data from 109 RA patients from regular clinic visits at Groote Schuur Hospital in Cape Town, South Africa have been entered in the Meteor database (from December 2016). The Meteor database is a free online tool that was developed to improve the management of RA patients by helping rheumatologists to register, monitor and tightly control disease activity. The tool is currently widely used in other countries, but has it has not yet been described in any African countries. Information on the following parameters were reported: demographics, disease duration, disease activity (CDAI), current DMARDs used and comorbidities.ResultsThe mean age (SD) was 57.6 (14.7) years, disease duration (SD) 14.1 (14.6) years, female gender 86.7%, RF positive 85.1% and ACPA positive 80.4%. The average (SD) CDAI was 13.1 (9.8) and 49.3% were smokers. Current DMARDs used was Methotrexate (72%), Sulphasalazine (29%), Chloroquine (67%), Low dose corticosteroids (47%), Leflunomide (11%), Etanacept (1%), but no other biological agents (0%). At least one comorbidity was present in 69% of the patients, two in 40%, three in 26%, four in 13% and five in 2% of the patients. The most frequently observed comorbid diseases were hypertension (45.5%), tuberculosis (TB) (11.1%), Diabetes Mellitis Type 2 (10.9%) and osteoarthritis (10.9%). Other diseases included hypercholesterolemia (7.1%), gastro-oesophageal reflux disease/peptic ulcer (6.1%), COPD/emphysema (6.1%), HIV (4.0%), hypothyroidism (4.0%), ischaemic heart disease (3.0%), liver disease (3.0%), DVT/pulmonary embolism (3.0%), malignancies (3.0%), asthma (2.0%), discoid lupus erythematosus (2.0%), interstitial lung disease (1.0%), anaemia (1.0%), rheumatic heart disease (1.0%), cerebrovascular accident (1.0%) and depression (1.0%).ConclusionsThis study shows a high prevalence of comorbidities among indigent patients with RA in South Africa. In particular, hypertension, TB and osteoarthritis were very common. More patients will be included in this study in the next few months. Furthermore, we will assess the association between comorbidities, disease activity and DMARD use. The METEOR tool offers the unique opportunity to study daily practice care as well as research questions in real life setting in a South African clinic. This study will provide informa...

We report the case of a 47-year-old female patient with rheumatoid arthritis and HIV infection presenting with a 3-week history of a painful swollen knee, increased serum inflammatory markers, and a low CD4 lymphocyte count. The diagnosis of TB arthritis was made by synovial fluid culture, GeneXpert/PCR, and confirmed by histopathology of a synovial biopsy. A mini literature review suggests that although HIV infection is associated with extrapulmonary TB, osteoarticular TB is a relatively unusual presentation in an HIV positive patient. The diagnostic utility of the GeneXpert test is explored. We also describe the patient's good response to an intra-articular corticosteroid injection in combination with standard anti-TB therapy.