Comorbid diseases and adverse events that occur in patients with rheumatoid arthritis (RA) negatively affect the outcomes of RA (radiological progression, joint function, the occurrence of low-energy fractures, thrombotic events, etc.). Objective: to study the structure of comorbid diseases and adverse events that occurred in patients with RA over the period of long-term prospective follow-up, to study the impact of these events on the dynamics of the functional status and working capacity of patients. Materials and methods. Аn open, cohort, prospective, long-term non-interventional study included 103 women with a definite diagnosis of RA (mean age 63.5 ± 8.3 years, follow-up period 8,5 ± 1,3 years). At baseline and in dynamics, standard laboratory and X-ray examinations were carried out. Results and discussion. There was a decrease in the DAS28 index and the number of patients with high or moderate activity [from 82 (85 %) to 67 (69 %), p = 0.02] against the background of an increase in the number of patients with remission or low activity [from 15 (15 %) to 30 (31 %), p = 0.012], at the same time there was an increase in the number of patients with ankylosis of joints [from 25 (24 %) to 41 (40 %), p = 0.017], functional class III [from 3 (3 %) to 15 (15 %), p=0.004], concomitant diseases [from 81 (79 %) to 94 (91 %), p = 0.015], thrombotic events [from 7 (7 %) to 18 (17 %), p = 0.027]. In 43 (42 %) patients 55 low-energy fractures were registered, in 24 (56 %) of them fractures occurred for the first time and in 19 (44 %) – repeatedly. Conclusion. As the prospective long-term follow-up shows, despite the decrease in RA activity, the number of patients with ankylosis, joint dysfunction and concomitant diseases increased. In the structure of concomitant diseases coronary heart disease and arterial hypertension dominated. A high incidence of thrombotic events, repeated and first-time low-energy fractures was noted. The number of disabled patients increased fivefold.

Patients' adherence to drug therapy, medical support and implementation of the doctor's recommendations for lifestyle changes can affect the effectiveness of therapy and quality of life in patients with rheumatoid arthritis (RA).Objective: to analyze adherence to treatment, medical support and implementation of recommendations for changing the lifestyle in RA patients, including those with and without low-energy bone fractures.Patients and methods. The study included 88 women with a definite diagnosis of RA. All patients were followed up for a long time (on average 8.45±1.34 years) at V.A. Nasonova Research Institute of Rheumatology. All patients underwent clinical, radiological and laboratory examinations, and a questionnaire for the quantitative assessment of adherence to treatment was completed.Results and discussion. The integral indicator of adherence to treatment in 30 (34%) patients corresponded to a low level, in 51 (58%) – to an average level, and in 7 (8%) – to a high level. Low adherence to medical support was more often determined in patients with anxiety (p=0.02) and depression (p=0.04). The intake of oral glucocorticoids (GC) was associated with a high adherence to drug therapy (p=0.01). Adherence rates in the group of RA patients with and without bone fractures did not differ significantly. Functional disorders and the severity of radiological changes also did not differ significantly in patients with different levels of adherence.Conclusion. Patients with RA had predominantly an average level of adherence to drug therapy, medical support, and a low level of adherence to recommendations for lifestyle changes. Oral GC were associated with high adherence to drug therapy, while low adherence to medical support was associated with anxiety and depression. Treatment adherence rates in the group of RA patients with and without bone fractures did not differ.