Incidence of noncardiac vascular disease in rheumatoid arthritis and relationship to extraarticular disease manifestations

Abstract

Objective. To investigate the incidence of noncardiac vascular disease in patients with rheumatoid arthritis (RA) and its relationship to systemic extraarticular disease in a community-based cohort.Methods. A retrospective medical record review of 609 patients with incident RA diagnosed during 1955-1994 was carried out in Olmsted County, Minnesota. Patients were followed up from 1955 to 2000 (median followup 11.8 years). Incident noncardiac vascular disease and severe extraarticular RA manifestations (including pericarditis, pleuritis, and vasculitis) were recorded according to predefined criteria, and incidence rates were estimated. Using Cox proportional hazards models, the risk (hazard ratio [HR]) of developing vascular events was assessed in patients with and without severe extraarticular RA.Results. Cerebrovascular and peripheral arterial events occurred in 139 patients (22.8%). The 30-year cumulative incidence rates of peripheral arterial events, cerebrovascular events, and venous thromboembolic events were estimated to be 19.6%, 21.6%, and 7.2%, respectively. The presence of severe extraarticular RA manifestations was found to be associated with all subgroups of noncardiac vascular disease except cerebrovascular disease alone (HR 2.3, 95% confidence interval [95% CI] 1.2-4.3 for peripheral arterial events; HR 3.7, 95% CI 1.3-10.3 for venous thromboembolic events; HR 1.5, 95% CI 0.7-3.2 for cerebrovascular events) after adjusting for age, sex, body mass index, smoking, and rheumatoid factor status.

Rheumatoid arthritis-associated lung disease

“…Patients with rheumatoid arthritis and more severe extra-articular disease are at even greater risk of venothromboembolism, supporting the hypothesis that some of the increase in risk is attributable to prothrombotic effects of chronic inflammation [86,87].…”

Inflammation in Peripheral Artery Disease

“…[65][66][67][68][69] Indeed, despite a clear distinction in their pathophysiology, rheumatoid arthritis and systemic lupus erythematosus share an inflammatory process that is strikingly similar to the process leading to atherosclerosis. 70 Unfortunately, however, most studies investigating the association of rheumatoid arthritis and systemic lupus erythematosus with PAD are small and cross-sectional.…”

“…70 Unfortunately, however, most studies investigating the association of rheumatoid arthritis and systemic lupus erythematosus with PAD are small and cross-sectional. 66 -69 An exception is the study by Liang et al 65 In this retrospective medical record review of 609 patients with incident rheumatoid arthritis diagnosed during 1955 to 1994, patients were followed up from 1955 to 2000 (median, 11.8 years) for incident noncardiac vascular disease. During follow-up, 68 patients (11%) developed PAD, with a 30-year cumulative incidence of 16.1%.…”

Rheumatoid arthritis and venous thromboembolic events

“…[33,34], частота пораже-ния периферических вен и артерий у больных РА при 30-летнем наблюдении составила 7,2 и 19,6% соответст-венно. В исследовании была установлена связь развития тяжелых внесуставных проявлений РА (серозиты, васкули-ты, гломерулонефрит, нейропатия, склерит) с вовлечением периферических сосудов [для венозной тромбоэмболии отношение шансов (ОШ) 3,7; 95% доверительный интер-вал (ДИ) 1,3-10,3; для артериальных тромбозов -ОШ=2,3; 95% ДИ 1,2-4,3].…”