Aortic aneurysm associated with rheumatoid arthritis: a population-based cross-sectional study

Abstract

There is substantial evidence that aortic aneurysm (AA) may be a manifestation of several systemic rheumatic disorders. However, only several studies have assessed the association between rheumatoid arthritis (RA) and AA. The aim of this study was to evaluate the incidence of AA in RA patients in a case-control study. A retrospective case-control study was performed utilizing the database of Clalit Health Services (CHS), a large healthcare provider organization in Israel. Data available from the CHS database included age, sex, socioeconomic status (SES), and diagnoses of chronic diseases, including AA. Patients over the age of 20 years who were diagnosed with RA ("cases") were compared with a sample of age- and gender-matched enrollees without RA ("controls") regarding the prevalence of AA. Chi-square and t tests were used for univariate analysis, and a logistic regression model was used for multivariate analysis. The study included 11,782 RA patients and 57,973 age- and gender-matched controls. The proportion of AA was significantly higher in RA patients (0.72 %) compared to the control group 0.49 % (odds ratio (OR) 1.48, 95 %; confidence interval (CI) 1.15-1.88; p = 0.002). A multivariate analysis that evaluated covariates associated with AA revealed an independent association of AA and RA after adjustment for different factors including age, gender, SES, and smoking status (OR 1.406, 95 %; CI 1.094-1.789; p = 0.006). Our study has demonstrated that AA is more prevalent in patients with RA in comparison with general population. Future large randomized studies are important to identify cardiovascular- and disease-related risk factors for AA formation in RA patients.

Are obesity and rheumatoid arthritis interrelated?

“…The study has an observational design and not an interventional one, which is an inherent limitation to any cross‐sectional study of this type. Previous experience with the CHS population‐based study has indicated that the data are of high quality and that the associations that were detected were identical to those that were observed when smaller groups of patients with definite diagnoses were used . Our study revealed statistically significant difference towards medium (but not high) SES among RA patients as compared with controls, but the difference was small and without an overt clinical impact.…”

Association Between Diverticular Disease and Abdominal Aortic Aneurysms: Pooled Analysis of Two Population Based Screening Cohorts

“…The observation that other chronic inflammatory conditions, for example rheumatoid arthritis, 22 are also associated with a higher prevalence of AAA, supports a direct effect of inflammation on aortic wall integrity, and prospective observational studies have found plasma cytokine levels (interleukins and C-reactive protein) to be significantly associated with aneurysm growth rates. 23,24 This may also indicate that diverticular inflammation contributes to the initiation of AAA, albeit the temporal relationship between diverticular disease and AAA could not be reliably determined in the present study.…”

Interleukin-6 Receptor Signalling and Abdominal Aortic Aneurysm Growth Rates

“…Tocilizumab is currently indicated in a few disease settings, including rheumatoid arthritis and giant cell arteritis, both of which are associated with an increased risk of aortic aneurysm. 45,46 The development of coronary artery aneurysms has also been reported in a non-placebo-controlled pilot study of tocilizumab in children with Kawasaki's Disease. 47 Our finding that blocking both the classic and trans-signalling IL-6 pathways using the animal-equivalent of tocilizumab was associated with decreased survival in the elastase + anti-TGFβ model provides some support that aortic aneurysm progression should be monitored in these patients.…”