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Rheumatoid arthritis linked to higher risk of venous thromboembolism

Rheumatoid arthritis suffers at risk for both deep vein thrombosis and pulmonary embolism

Recent reports have suggested rheumatoid arthritis may be a risk factor for venous thromboembolism (VTE) especially during hospitalization and the elevated risk remains constant for ten years after diagnosis.

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In this new study researchers estimated risks for VTE in patients with rheumatoid arthritis (RA) which included the association of these risks of disease duration and hospitalization.

Dr. Marie E. Holmqvist, M.D., Ph.D., of the Karolinska Institutet, Stockholm, Sweden, and colleagues assessed 45,750 patients that included 37,859 patients prevalent RA and 7,904 patients of incident RA and matched general population comparison groups all from Sweden, with follow-up from 1997 to 2010.

The findings revealed patients with rheumatoid arthritis were at a greater risk for VTE 5.9% in comparison to the general population at 2.7% per 1,000 persons each year. There was no statistically significant association between a history of VTE and RA by the time of RA symptom onset.

Rheumatoid arthritis patients had an increased risk for VTE (3.8%) in comparison to the control group at 2.4% however, after the first ten years the risk did not increase.

The researchers also found that although rates for VTE after hospitalization were higher, the one year rate of VTE was not higher in the RA cohort than in the comparison cohort after hospitalization. The rates of VTE increased with age but were largely similar across sex and rheumatoid factor status.

The researchers wrote “The results of this study suggest that patients with RA are at increased risk of 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.”

"Hospitalization is a strong risk factor for VTE in the general population and in patients with RA, but the short-term (<1 year after hospital discharge) rates for VTE are similar in both groups. VTE rates varied with age, less so with sex, calendar period of RA diagnosis, and rheumatoid factor status, but the relative risks of VTE were largely similar across these patient subgroups."

This study is published in the Journal of the American Medical Association.

In a different study this year conducted by Mayo Clinic researchers in Rochester, found that patients with rheumatoid arthritis are not only at an increased risk for VTE but also cardiovascular disease.

The study included 556 women and 257 men with an average age of 56 at the time of diagnosis for RA. Two-thirds of the patients were positive for rheumatoid arthritis factor with the average length of follow-up being nearly ten years.

The findings included thromboembolism was more than three times more likely in RA patients than in controls.

In both patients and controls, the risk of venous thromboembolism rose significantly during the three months after a hospital admission, but after adjustment for hospitalization, the difference in risk between patients and controls remained.

The study appeared in the January issue of Arthritis and Rheumatism.

Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in your hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

Rheumatoid arthritis affects almost two million Americans but is more common in women than men and usually occurs between the ages of 40 and 60.

More information on rheumatoid arthritis can be found at the Arthritis Foundation website.