OBJECTIVES: Rheumatoid arthritis (RA) is a chronic, systemic disease associated with comorbidities and extra-articular manifestations (EAM) . The main objective of the study was to estimate the frequency and impact of comorbidities and EAM in well-defined RA patients.  METHODS: A prospective study was conducted at a tertiary care hospital between the years 2009 & 2012. Patients (age ≥ 18 years) with RA, fulfilling the revised criteria of the American college of rheumatology (1987 & 2010), were enrolled in the study. Standard clinical, laboratory and radiological measures of RA and details of comorbidities and EAM were recorded using patient hospital records. RESULTS: Of 602 RA patients, 481 (79.9%) females and 121 (20.1%) males were present. Mean age of 47.57±12.78 years, mean disease duration of 4.52±4.75 years and mean days of hospitalization 6.44±4.47 were observed. Disease duration of more than 2 years was observed in 336 (55.8%) patients.  RA alone, RA with 1 comorbidity, RA with 2 comorbidities,  RA with 3 comorbidities,  RA with 4 comorbidities,  RA with 5 comorbidities, were present in 227 (37.7%), 171 (28.4%), 118 (19.6%), 58 (9.6%), 19 (3.2%), 9 (1.5%) patients respectively. The most common comorbidities were diabetes mellitus 114 (18.94%), hypertension 104 (17.28%) and EAM was anemia 351 (58.30%). CONCLUSIONS: Comorbidities and EAM were present in substantial proportion of RA patients.  Diabetes mellitus, hypertension and anemia were found to be most common in our setting. Early diagnosis and management are necessary to reduce their impact on therapeutic outcomes in RA.