title: 2012 Brazilian Society of Rheumatology Consensus on the management of comorbidities in patients with rheumatoid arthritis.
abstract: 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.
  
  
  CONCLUSIONS
  
  
  
  CONCLUSIONS
  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.
authors.affiliation: Universidade do Sul de Santa Catarina, Florianópolis, SC, Brazil. ivanioreumato@gmail.com
authors.forename: Ivânio Alves
authors.initials: IA
authors.lastname: Pereira
authors.forename: Licia Maria Henrique da
authors.initials: LM
authors.lastname: Mota
authors.forename: Boris Afonso
authors.initials: BA
authors.lastname: Cruz
authors.forename: Claiton Viegas
authors.initials: CV
authors.lastname: Brenol
authors.forename: Lucila Stange Rezende
authors.initials: LS
authors.lastname: Fronza
authors.forename: Manoel Barros
authors.initials: MB
authors.lastname: Bertolo
authors.forename: Max Victor Carioca de
authors.initials: MV
authors.lastname: Freitas
authors.forename: Nilzio Antônio da
authors.initials: NA
authors.lastname: Silva
authors.forename: Paulo
authors.initials: P
authors.lastname: Louzada-Junior
authors.forename: Rina Dalva Neubarth
authors.initials: RD
authors.lastname: Giorgi
authors.forename: Rodrigo Aires Corrêa
authors.initials: RA
authors.lastname: Lima
authors.forename: Geraldo da Rocha Castelar
authors.initials: Gda R
authors.lastname: Pinheiro
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D006801:Humans