Venous thromboembolism events among RA patients

Abstract

Background: Rheumatoid arthritis (RA) is associated with an increased risk for venous thromboembolism. However, so far, relatively few and small size-based studies have been conducted. We aimed to investigate the link between RA and venous thromboembolism utilizing a large sample of subjects originating from a large data base. Materials and methods: The study was performed utilizing the medical database of Clalit Health Services, the largest healthcare provider in Israel. We enrolled all patients with RA and age-and gender-matched controls. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for a multivariate analysis. RA patients were compared to controls regarding the proportion of venous thromboembolic events (defined as deep vein thrombosis, pulmonary embolism or both). Multivariate logistic regression was employed to assess factors associated with thromboembolic events. Results: The study included 11,782 patients with RA and 57,973 age-and gender-matched controls. RA patients had a higher rate of venous thromboembolism events compared with controls (6.92% vs. 3.18%, respectively, p<0.001). RA and mean C-reactive protein levels were found to be independently associated with the proportion of thromboembolic events (OR 2.27 for RA and 1.07 for each 1 mg/dL increment of mean C-reactive protein, respectively). Conclusion: RA and C-reactive protein levels are independently associated with venous thromboembolic events. Physicians should be aware of such findings and have a lower threshold for suspecting detecting such events in patients with RA, mainly those with mean high levels of C-reactive protein.

Mediterranean Journal of Rheumatology March 2019 Highlights

“…In the current issue age-and gender-matched controls. 2 In line with previous reports, they demonstrated an increased risk of deep vein thrombosis in RA patients which was associated with high CRP levels. These findings confirm once more the tight link between inflammation and vascular disease and underscore the continuous need for optimal control of RA.…”

“…In their editorial, Bragazzi et al 1 discuss how data originating from large population-based databases could contribute to the decision making and improve clinical practice. They comment on the study of Mansour et al, 2 who collected data from a large health provider organization in Israel. The authors look back to the first steps of rheumatology and present how data collection in this field has evolved over the last 150 years.…”

Risk of venous thromboembolism in immune-mediated inflammatory diseases: a UK matched cohort study

“…2 3 Inflammation increases the risk of VTE, 4 and observational data demonstrate higher VTE rates in individuals with immunemediated inflammatory diseases (IMID) including ulcerative colitis (UC), Crohn's disease (CD) and rheumatoid arthritis (RA) compared with the general population. [5][6][7][8][9] Evidence for VTE risk in other inflammatory diseases, including psoriatic arthritis (PsA) is more limited. 6 Risk factors for VTE have been well described in the general population, and include obesity, fractures, surgery, use of oral corticosteroids and hormone therapies.…”

From Rheumatology 1.0 to Rheumatology 4.0 and beyond: the contributions of Big Data to the field of rheumatology

“…In a previously published systematic review of the literature and meta-analysis, 2 a pooled risk ratio of 1.90 (95%CI 1.76-2.06) of VTE episodes in RA patients had been found. Mansour et al 1 have replicated this finding, confirming the existence of such link. Taken together, all these results warrant the role of thromboprophylaxis in immune mediated disorders, such as RA.…”

“…In their paper, Mansour and colleagues 1 have explored the relationship between rheumatoid arthritis (RA) and venous thromboembolism (VTE), an association which has been relatively overlooked by the existing scholarly literature, despite mounting evidence suggesting a link between coagulation factors and pro-inflammatory molecules. The majority of the previous studies has employed small sample sizes, being generally statistically underpowered, except for few notable exceptions.…”