The risk of pulmonary embolism and deep vein thrombosis in rheumatoid arthritis: a UK population-based outpatient cohort study

Choi, Hyon K.; Rho, Young-Hee; Zhu, Yanyan; Soriano, Lucía Cea; Aviña‐Zubieta, J Antonio; Zhang, Yuqing

doi:10.1136/annrheumdis-2012-201669

Cited by 125 publications

(103 citation statements)

References 45 publications

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“…Previous studies have demonstrated an increased risk of deep vein thrombosis and pulmonary embolism in patients with RA relative to the age and sex-matched general population without RA, likely due to the effects of systemic inflammation and endothelial dysfunction (50,51). Our findings may be the result of selection bias; it may be that healthier patients with RA are selected for THA and/or there may be an overall higher risk of venous thromboembolism among patients with advanced OA relative to the age and sex-matched general population without OA (52).…”

Section: Discussionmentioning

confidence: 98%

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Ravi

Croxford

Hollands

et al. 2014

Arthritis & Rheumatology

169

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Objective. Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are based on patients with osteoarthritis (OA); less is known about outcomes in rheumatoid arthritis (RA). Using a validated algorithm for identifying patients with RA, we undertook this study to compare the rates of complications among THA and TKA recipients between those with RA and those without RA.Methods. In patients who underwent a first primary elective THA or TKA between 2002 and 2009, those with RA were identified using a validated algorithm: a hospitalization with a diagnosis code for RA or 3 physician billing claims with a diagnosis code for RA, with at least 1 claim by a specialist (rheumatologist, orthopedic surgeon, or internist) in a 2-year period. Recipients with diagnostic codes suggesting an inflammatory arthritis, but not meeting RA criteria, were classified as having inflammatory arthritis. All remaining patients were deemed to have OA. Cox proportional hazards models, censored on death, were used to determine the relationship between the type of arthritis and the occurrence of specific complications, adjusting for potential confounders (age, sex, comorbidity, and provider volume).Results. We identified 43,997 eligible THA recipients (3% with RA) and 71,793 eligible TKA recipients (4% with RA). Total joint arthroplasty recipients with RA had higher age and sex-standardized rates of dislocation following THA (2.45%, compared with 1.21% for recipients with OA) and higher age and sex-standardized rates of infection following TKA (1.26%, compared with 0.84% for recipients with OA). Controlling for potential confounders, recipients with RA remained at increased risk of dislocation within 2 years of THA (adjusted hazard ratio [HR] 1.91, P ‫؍‬ 0.001) and remained at increased risk of infection within 2 years of TKA (adjusted HR 1.47, P ‫؍‬ 0.03) relative to recipients with OA.Conclusion. Patients with RA are at higher risk of dislocation following THA and are at higher risk of infection following TKA relative to those with OA. Further research is warranted to elucidate explanations for these findings, including the roles of medication profile, implant choice, postoperative antibiotic protocol, and method of rehabilitation following joint replacement.

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Section: Discussionmentioning

confidence: 98%

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Ravi

Croxford

Hollands

et al. 2014

Arthritis & Rheumatology

169

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“…Together, deep venous thrombosis and pulmonary embolism constitute venous thromboembolism, the risk of which is increased in patients with rheumatoid arthritis and other autoimmune disorders (2)(3)(4)(5)(6)(7). A possible mechanism may relate to the increased inflammation characteristic of these diseases, but the exact etiology is unknown (8 ).…”

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confidence: 99%

Increased Rheumatoid Factor and Deep Venous Thrombosis: 2 Cohort Studies of 54628 Individuals from the General Population

2015

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BACKGROUND The risk of deep venous thrombosis is increased in patients with rheumatoid arthritis. We tested the hypothesis that increased concentrations of rheumatoid factor are associated with increased risk of deep venous thrombosis in individuals without autoimmune rheumatic disease in the general population. METHODS We included 54628 participants from the Copenhagen City Heart Study (1981–83) and the Copenhagen General Population Study (2004–12), all with a measured concentration of IgM rheumatoid factor and without autoimmune rheumatic disease or venous thromboembolism. The main outcome was incident deep venous thrombosis. There were no losses to follow-up. RESULTS During 368381 person-years, 670 individuals developed deep venous thrombosis. A rheumatoid factor concentration ≥ vs <110 IU/mL showed the strongest association with deep venous thrombosis, with multivariable adjusted hazard ratios of 9.0 (95% CI 3.1–26) for 1-year follow-up, 4.3 (2.2–8.5) for 5-year follow-up, and 3.1 (1.7–5.6) for up to 32 years of follow-up. Compared with rheumatoid factor concentrations <15 IU/mL, the multivariable adjusted hazard ratios for deep venous thrombosis during maximum follow-up were 1.3 (1.0–1.5) for 15–29 IU/mL, 1.7 (1.0–2.8) for 30–59 IU/mL, 2.4 (1.3–4.3) for 60–119 IU/mL, and 3.0 (1.6–5.6) for ≥120 IU/mL (trend P = 6 × 10−7). Results were similar in the 2 studies separately. Obese men and women age >60 years with rheumatoid factor concentrations ≥120 IU/mL had 10% and 8% 5-year risk of deep venous thrombosis. CONCLUSIONS Increased rheumatoid factor in the general population was associated with up to 3-fold increased long-term risk and up to 9-fold increased 1-year risk of deep venous thrombosis.

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“…Risk probably remains elevated, although to a much lower degree, during remission. Such risk has been calculated (1.0 per 100 person-years) in only 1 study 4 and was not formally compared to the published data on healthy persons available at the time 5 ; but dissection of data from the other studies of VTE in AAV 1,2,3 and addition of data from new and very large cohorts of healthy persons support the statement that the relative risk of VTE during quiescent AAV is elevated, probably to about the same degree as in rheumatoid arthritis or inflammatory bowel disease 6,7,8 . The increased risk of VTE in AAV, regardless of disease activity, cannot be attributed to the known risk factors for VTE 2,4,9 .…”

mentioning

confidence: 89%

“…It is well established that active antineutrophil cytoplasmic antibody-associated vasculitis (AAV) -granulomatosis with polyangiitis (Wegener's; GPA) or microscopic polyangiitis -is associated with a very high risk of venous thromboembolic events (VTE): about 7 per 100 person-years 1,2,3,4 , compared to 0.15-0.31 in the general population 5,6,7 . Risk probably remains elevated, although to a much lower degree, during remission.…”

mentioning

confidence: 99%

ANCA-associated Vasculitis: A Prothrombotic State Even in Remission?

Monach

2013

J Rheumatol

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The risk of pulmonary embolism and deep vein thrombosis in rheumatoid arthritis: a UK population-based outpatient cohort study

Abstract: This population-based study indicates an increased risk of PE and DVT in RA, supporting increased monitoring of venous-thromboembolic complications and risk factors in RA, regardless of hospitalisation.

Cited by 125 publications

References 45 publications

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Increased Rheumatoid Factor and Deep Venous Thrombosis: 2 Cohort Studies of 54628 Individuals from the General Population

ANCA-associated Vasculitis: A Prothrombotic State Even in Remission?

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