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Background: The risk of Venous thromboembolisim (VTE) is increased and is an important cause of mortality and morbidity in rheumatoid arthritis. In addition to the underlying Rheumatoid arthritis(RA), there are a number of predisposing risk factors for VTE(1).
Objectives: In this study, we aimed to evaluate the demographic and clinical features of rheumatoid arthritis patients with VTE.
Methods: Patients who were refered to Hacettepe University Medical Rheumatology department from January 2021 to December 2021 retrospectively analyzed. A total 981 RA patients were detected according to the ICD code(M05, M06, MO07). RA diagnosis was confirmed in 400 patients according to 2010 ACR/EULAR criteria. Venous thrombosis was confirmed by ICD code(I26,I74,I82), computed torax tomography, lower extremity venous doppler and medical treatment report in these 400 patients with RA. Thromboembolism was detected in 58 patients during follow-up. The patients’ clinical characteristics, serological features, co-morbidities, and treatment were systematically analysed.
Results: VTE was diagnosed in 58 patients with RA. Of these patients, 84,5% was female and mean (SD) age was 67.5 ± 11,1 years. The majority of patients had deep venous thrombosis (53.4%). Rate of rheumatoid factor and/or anti-cyclic citrullinated peptid positivity was 72.5% and ANA positivity was 68% respectively. Distribution of cDMARDs and bDMARDs before VTE was as follows: methotrexate 18 (45%), leflunomide (35%), sulfasalazine (22.5%), hydroxychloroquine (47.5%), steroid (47.5%), biological agents (22.5%). Comorbidities were common and The Charlson Comorbidity Index score was ≥3 in 89.6% of patients with VTE. VTE frequency of patients in the last 1 year was %1.27.
Conclusion: All RA patients with VTE had at least one comorbidity and 89% of patients had multi-morbidities. RA patients with multimorbidity may have an increasded risk of VTE. In the management of RA, comorbidities should be taken into account.
REFERENCES:
[1]Ketfic, Boutigny A, et al. Risk of venous thromboembolisim in rheumatoid arthritis Joint Bone Spine 2021 May;88(3) 105122
Demographic, Clinic and treatment Features of venous thromboembolisim with RA
| Demographic, Clinic and treatment Features | VTE in RA patients N=58(%) |
|---|---|
| Age, years, mean(SD) | 67,5 (±11.1) |
| Female, n(%) | 49(84.5) |
| Charlson Comorbidity Index score(CCI) | |
| ○ CCI1 | 2(3.4) |
| ○ CCI2 | 4(6.8) |
| ○ CCI3 and higher | 52(89.6) |
| Smoking, ever, n(%) | 20 (41.6) |
| Presentation of Venous thromboembolism | |
| ○ deep vein thrombosis, n(%) | 27(46.6) |
| ○ pulmonary thromboembolism, n(%) | 26(44.8) |
| ○ DVT+PTE, n(%) | 5(8.6) |
| Treatment before venous thrombosis, n(%) | |
| ○ Methotrexat | 18(45) |
| ○ Leflunomid | 14(35) |
| ◦ ○ Sulfasalazin | 9(22.5) |
| • Hydroxychloroquine | 19(47.5) |
| • Biologic agents | 9(22.5) |
| • Steroid | 19(47.5) |
| Treatment, ever, n(%) | |
| • Methotrexat (n=44) | 39(88.6) |
| • Leflunomid(n=42) | 24(52.1) |
| • Sulfasalazin(n=47) | 29(62) |
| • Hydroxiclorokine(n=49) | 44(89) |
| • Steroid(n=54) | 50(92.5) |
| • Tofacitinip | 19(34.5) |
| • Biologic agents | 2(0.03) |
| ○ Abatacept | 3(0.05) |
| ○ Adalimumab | 5(0.09) |
| ○ Etanercept | 3(0.05) |
| ○ Rituximab | 9(16) |
| ○ Certolizumab | 1(0.01) |
| ○ İnfliximab | 1(0.01) |
| Comorbidity, n(%) | 35(60.3)10(17.2)40(70.2)11(19)8(13.8)8(13.8)15(30.6)5(8.6)7(12.5) 10(25.6)8(13.8) 54(93.1) |
| CRP/mg/dl at venous thrombosis, mean, (SD) | 0.98(±5.2) |
| Erytrochyte Sedimentation rate/mmhour at venous thrombosis, mean,(SD) | 25 (±22.3) |
| Seropositive, n(%) | 41 (73.2%) |
| ANA positive, n(%) | 34 (68%) |
Disclosure of Interests: None declared