Background/Purpose: Increased risk of venous thromboembolism (VTE) has been reported in rheumatoid arthritis (RA) compared to the general population. However, factors associated with the risk of VTE have been barely studied in RA. Our objective was to identify classical or disease-related risk factors of VTE in RA patients in clinical practice.

Methods: Retrospective observational study performed on all RA patients fulfilling the 2010 ACR/EULAR clarification criteria attending the one-day hospitalization program of the Rheumatology department, Cochin hospital, in 2021. We used the electronic medical report to identify the occurrence of VTE in 2021 and collect RA disease characteristics and risk factors for VTE. Multivariate analysis by logistic regression was performed to determine the factors independently associated with VTE.

Results: We included 405 RA patients (330 females, 81%), with a mean age of 59±14 years and a mean disease duration of 16±13 years. Positive rheumatoid factor and positive anti-CCP antibodies were detected in 331 (82%) and 347 (86%) patients respectively. 252 patients (62%) had bone erosions. The mean DAS28 was 3.5±1.4 ; 218 patients (48%) received corticosteroids (mean dose 2.6±3.3 mg/L), 247 (61%) methotrexate, and 151 (54%) targeted biologic or synthetic DMARDs (b/tsDMARDs), including 72 on TNF inhibitors, 70 on rituximab and 39 on JAK inhibitors (13 baricitinib, 7 tofacitinib 17 upadacitinib and 2 filgotinib). We identified 15 (4%) venous thromboembolic events that occurred in 2021, including 11 PVT and 8 PE (incidence of 3.7 for 100 patient/year). The mean duration between the occurrence and VTE and the visit was 3.6±4.8 months. Among these 15 VTE patients, 11 were women (73%, vs. 82% in patient without VTE), with a mean age of 65±12 years (vs. 59±14, p=0.11). Age >65 years was more frequent in patient with VTE (60% vs. 33%, p=0.030); 4 (27%) patients with VTE had a history of previous VTE (vs. 3%, p< 0.001), 9 (60%) were hospitalized up to 6 months before the event (vs. 6%, p< 0.001), 5 (33%) experienced surgery up to 3 months bfore the event (vs. 2%, p< 0.001) and 4 (33%) had a history of fracture (vs. 3%, p< 0.001). No difference was oberved regarding body mass index, the frequency of smoking, neoplasia, recent travel (up to 3 months) and estrogen/antidepressant therapies. No patient had thrombophilia. Regarding RA characteristics, patients with VTE were more likely to present extra-articular manifestations (67% vs. 35%, p=0.011) and higher CRP levels (18±35 mg/L vs. 6.3±13 mg/L, p=0.007). They also received more frequently corticosteroids (73% vs. 47%, p=0.048) and JAKi (27% vs. 9%, p=0.021). Disease duration, autoantibody status, frequency of erosions, DA28 and treatment with methotrexate or bDMARDs did not differ between these 2 groups. Logitic regression analysis identified history of previous VTE, hospitalization, surgery and treatment with JAKi as independently associated with the occurrence of VTE (Table 1).

Conclusion: History of VTE was identified as the strongest risk factor of the occurrence of VTE. Our results suggest a specific warning on recent hospitalization and surgery as precipitating events to VTE.As recommended by the PRAC JAKi should be used with caution in patients with risk factors for VTE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-associated-with-venous-thromboembolism-in-rheumatoid-arthritis-in-clinical-practice/