Background/Purpose: Rheumatoid arthritis (RA) is an immune-mediated synovial disease with chronic inflammation. Systemic inflammation is considered one of risk factors for venous thromboembolism (VTE), which includes both deep venous thrombosis (DVT) and pulmonary embolus (PE). RA patients are thought to be at risk of developing thromboembolic events due to multiple factors. However, less is known about association of systemic inflammation and VTE in patients with RA. We aimed to clarify the clinical features and risk factors of VTE in RA patients.

Methods: We retrospectively reviewed the prevalence of VTE in RA patients who visited Hokkaido University Hospital with more than 2 years follow-up from 2010 to 2019. In this study, 28 cases diagnosed with VTE were identified during that period. All patients fulfilled 2010 American College of Rheumatology (ACR)/ European League Against Rheumatism (EULAR) classification criteria. VTE was confirmed by the venous ultrasound and/or enhanced CT regardless of symptoms. The patients who had been diagnosed with DVT or PE prior to 2010, or had used anticoagulant and/or antiplatelet drugs were excluded. To evaluate the risk factors for the development of VTE, we randomly selected 144 patients without VTE (non-VTE) and registered demographic, clinical, and treatment profile. Disease Activity Score-28 for Rheumatoid Arthritis (DAS28) were calculated in VTE cases and in non-VTE cases at the last regular follow-up visits before onset of the VTE and within the study period, respectively. The risk factors were identified by multivariate logistic regression analysis. The study was approved by the Institutional Review Board of Hokkaido university Hospital.

Results: This study comprised a total of 1379 cases (1076 women/303 men; median age at diagnosis 54 years [Interquartile range (IQR) 42-64]) and median follow up duration was 7 years (IQR 5-9). The prevalence of VTE was 0.20 % (28 of 1379 cases) and the median age at the time of diagnosis of VTE was 74 years (IQR 65.5-79). The rate of female patients was 72.9 %. In the VTE cases, five (17.9%) and three (10.7%) patients had history of orthopedic surgery and malignant disease, respectively. Univariate analysis showed no difference between VTE and non-VTE in the presence of smoking history, hypertension, dyslipidemia, diabetes mellitus, chronic kidney disease, and treatment with JAK inhibitor or NSAIDs. Body mass index (BMI), the presence of interstitial lung diseases and glucocorticoid usage were identified as risk factors of VTE (p=0.001). Furthermore, the rates of moderate and high disease activity in RA (DAS28CRP > 2.7) were higher in VTE cases compared to non-VTE cases (p=0.01). In multivariate logistic regression analysis, high disease activity in RA was significantly associated with the development of VTE (p= 0.02, Odds Ratio 5.88, 95% Confidence Interval 1.32-26.17).

Conclusion: High disease activity in RA was identified as a risk factor of VTE, suggesting that clinical remission would be beneficial for preventing VTE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-between-the-risk-of-venous-thromboembolism-and-disease-activity-in-patients-with-rheumatoid-arthritis-a-retrospective-observational-study/