Background/Purpose:

We performed a meta-analysis investigating the risk of developing deep vein thrombosis (DVT) and/or pulmonary embolisms (PE) in patients with inflammatory arthritis, vasculitis, and connective tissue diseases (CTD) [SLE, Sjogren’s syndrome, inflammatory myositis and systemic sclerosis (SSc)].

Methods:

PubMed, Embase, Cochrane Databases, and Medline were searched identifying full text English publications in adults related to rheumatologic inflammatory diseases and VTE. Data regarding rates of DVTs and PEs were extracted. Using random effects models, pooled estimates for VTE in individual and pooled diseases compared with matched populations where possible. Studies were excluded if VTEs were in the setting of pregnancy, postoperative outcomes or solely antiphospholipid antibody syndrome.

Results:

Most of the 3,929 studies were excluded due to lack of rate or incidence of VTE. Twenty studies remained for analysis. Eight studies of RA identified 5,273,942 patients and 891,530,181 controls with a cumulative incidence of 2.18% (95% CI: 1.82–2.54%) and an odds ratio of 2.23 (95% CI: 2.02–2.47) compared to age and sex, matched population. Six studies included 36,582 SLE patients with a cumulative incidence of 8.24% (95% CI: 6.27–10.22%); three Sjogren’s syndrome studies (N=16,180) demonstrated a VTE cumulative incidence of 2.62% (95% CI: 2.15–3.10%); four studies of inflammatory myositis (N=8,245) yielded a VTE cumulative incidence of 4.03% (95% CI: 2.38–5.67%), SSc and ANCA vasculitis rates (3 studies each) were 3.82% and 8.51% respectively. The figure shows VTEs in RA as an example.

Conclusion:

Inflammatory rheumatologic diseases studied were all associated with high rates of VTEs, more nearly three times higher than the general population. Identification of those at risk is important. We cannot determine from these studies what the risk is when inflammation is effectively treated.