EULAR Report: High Disease Activity in RA Linked to Venous Thromboembolism

One in a 100 rheumatoid arthritis patients with high disease activity will develop a venous thromboembolism, a more than twofold increase compared to patients in remission, according to results from a Swedish cohort study presented at the European Congress of Rheumatology (EULAR) annual meeting last week.

“These findings highlight the need for proper venous thromboembolism risk assessment in patients with active rheumatoid arthritis (RA), and confirm that patients with highly active RA are already at particularly elevated risk of venous thromboembolism,” said Viktor Molander, of the Karolinska Institutet in Stockholm, Sweden.

Rheumatoid arthritis has been linked to an increased risk of venous thromboembolism, including deep vein thrombosis and pulmonary embolism, and several risk factors, such as immobilization and comorbidities, occur more often in rheumatoid arthritis patients. Previous studies have suggested that inflammation may also increase venous thromboembolism risk, as may the use of certain medications, including the JAK-inhibitor tofacitinib.

This study looked at whether the degree of disease activity in rheumatoid arthritis had an impact on venous thromboembolism risk. Data from 46,311 rheumatoid arthritis patients taken from the Swedish Rheumatology Quality Register over a period of 12 years were analyzed. Among these, 2,257 visits in 1,345 individuals were followed by a venous thromboembolism within a one-year window.

The one-year risk of a venous thromboembolism increased from 0.5 percent in patients in Disease Activity Score 28 (DAS28) remission, to 1.1 percent in patients with DAS28 greater than 5.1. The age- and sex-adjusted odds ratio for a venous thromboembolism event in highly active rheumatoid arthritis compared with disease in remission was 2.12 (95% CI 1.80-2.47).

“This study demonstrates a strong association between clinical RA inflammatory activity as measured through DAS28 and risk of venous thromboembolism,” Dr. Molander said.

Meanwhile, results from a registry review presented at the EULAR annual meeting found that the risk of major venous thromboembolism events is reduced by almost 50 percent with tumor necrosis factor inhibitor use compared with the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in rheumatoid arthritis.

Martin Schäfer, M.D., of the German Rheumatism Research Center in Berlin, and colleagues analyzed the data of more than 11,000 rheumatoid arthritis patients in the German RABBIT register, who were treated either with another csDMARD after at least one csDMARD failure, or whose treatment was switched to biologic DMARD. Better physical function also reduced the risk of serious venous thromboembolism events, while age above 65 years and high CRP levels increased this risk.

REFERENCE

OP0034 (2020) Does The Risk Of Venous Thromboembolism Vary With Disease Activity In Rheumatoid Arthritis? Viktor Molander. 2020 EULAR E-Congress

OP0012 (2020) TNF Inhibitors Are Associated With A Reduced Risk Of Venous Thromboembolism Compared To CSDMARDS In RA Patients. Martin Schäfer, M.D. 2020 EULAR E-Congress