Background/Purpose: Several factors including disease process and drug therapy allegedly predispose to infections in RA. Socioeconomic constraints on our setting impose unique impediments. RTI are rampant in younger women (WHO, 1999). Similar data in RA is woefully lacking.

Methods:  A convenience sample of 400 consenting patients (ACR 1988 classified, age group 15-49 years, median disease duration 3 years, 80% RF/CCP seropositive) under supervised standard rheumatology care in a popular community center (CRD) were selected. On physician global assessment, patients were classified 10% asymptomatic, 56% mild, 34% moderate-severe [88% methotrexate, 33% chloroquin, 46% prednisolone (< 7.5 mg daily)]. 32 patients recalled past urinary tract infections and 6 had concurrent diabetes. Patients were interviewed comprehensively using a-priori validated relevant questionnaires. Gynecological examination was supervised by a senior gynecologist (RR).Vaginal smears (wet mount) were quickly examined (gold standard) by microbiologist (AV) to diagnose RTI as per WHO recommendations for community based management of RTI in developing countries; classified into bacterial vaginosis (includes gonococci/chlamydia),candida and trichomonas infections. No further culture/characterization studies were carried out. Standard methods used for statistical analysis (SPSS). Sample size of 384 subjects was calculated based on ~40% prevalence of RTI (Government of India Family Health Survey 1998-99).

Results: Prior to this study, none of the patients had ever volunteered or been questioned on RTI in our setting. Currently, relevant symptoms and clinical signs were recorded by 42% and 45% patients respectively. 39.3% cohort were diagnosed RTI; 32% bacterial vaginosis, 6.5% candidiasis, 0.8% trichomoniasis. 26% of RTI were asymptomatic; 9% lacked signs. A combination of vaginal itching and discharge and low back pain was 100% sensitive and 83.7% specific for diagnosis of RTI. None tested seropositive for syphilis. Some relevant features pertaining to QOL and functional ability were – HAQ (Indian version) disability classify- 84% mild, 16% moderate-severe; SF-36 data-61% moderate severe body pain and ~8% with major limitation on bathing/dressing. Several independent significant (p<0.05) risk factors for RTI( on univariate analysis/ logistic regression) were identified -notably * Age< 30 years, *small house, public toilet, *use of indigenous sanitary pads during menses,*difficulty/inability for certain physical activities (bathing, toilet use, lifting/carrying groceries, arising from floor), nervousness, * DMARD use (not an individual drug or steroid except chloroquine). Those marked with asterisk remained significant in a multivariable analysis; adjusted odds ratio for DMARD use 3.96 (95% confidence interval 1.9, 7.9).

Conclusion: This cross sectional community based clinical study unraveled a large burden of RTI in women suffering from RA. Surprisingly, the prevalence was similar to national statistics. However, regular screening algorithms for RTI are urgently required to prevent neglect and improve overall standard care in rheumatology practice.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/reproductive-tract-infections-rti-in-indian-asian-women-of-child-bearing-age-suffering-from-rai-dont-ask-them-they-dont-tell-me/