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VTE risk greater among RA patients than general population
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Patients with rheumatoid arthritis had an elevated risk for venous thromboembolism compared with the general population, and it remained stable during the first decade after diagnosis, according to study data.
Researchers in Sweden designed a prospective, population-based study that evaluated a prevalent rheumatoid arthritis (RA) cohort (n=37,856), an incident RA cohort (n=7,904) and matching general population cohorts (n=169,921, prevalent RA; n=37,350, incident RA) from 1997 through 2010. First-time venous thromboembolism (VTE) was the main outcome measure.
Patients with prevalent RA had a greater risk for VTE compared with the matching cohort (5.9 per 1,000 person-years vs. 2.6 per 1,000 person-years; adjusted HR=2.0) (95% CI for all). There was no statistically significant association between a history of VTE and RA at onset of RA symptoms (adjusted OR=1.2; 95% CI, 1.0-1.4), with 150 events in the RA cohort compared with 587 in the comparison group. Within the first year of RA diagnosis, the RA cohort had an increased rate for VTE vs. the comparison cohort (3.8 per 1,000 person-years vs. 2.4 per 1,000 person-years; HR=1.6)(95% CI for all), but it increased no further during the first 10 years.
Although VTE rates following hospitalization were higher, the RA cohort’s 1-year rate of VTE per 1,000 person-years was lower than the comparison cohort after discharge (11.8 vs. 13.1; HR=1.0) (95% CI for all). VTE rates increased with age, but remained similar across gender and rheumatoid factor status. Hazard ratios for VTE were similar for age , gender and rheumatoid factor status.
“The results … suggest that patients with RA are at increased risk for VTE [both deep vein thrombosis and pulmonary embolism] and that the risk of VTE increases shortly after RA diagnosis and remains similarly elevated during the first decade,” the researchers said. “Hospitalization is a strong risk factor for VTE in the general population and in patients with RA, but the short term [less than1 year after hospital discharge] rates for VTE are similar in both groups.”
Disclosure: See the study for a full list of relevant disclosures.
Perspective
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Harry S. Jacob, MD, FRCPath(Hon)
These results are not surprising in that the T1/T2 ratio of synovial lymphocytes is five times greater in rheumatoid arthritis than in other serologic-negative arthropathies. The resulting increased production of procoagulant proteins such as gamma interferon, tumor necrosis factor and C-reactive protein presumably underlie these results. I wonder whether the chronic anticoagulants required in rheumatoid arthritis patients after DVT might cause crippling hemarthroses in these patients.
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