Patients With Hospitalized IBD and RA Have Higher Cardiovascular, Kidney Injury Risk

Sajana Poudel, MD

Credit: Research Gate

Patients hospitalized with irritable bowel disease (IBD) with rheumatoid arthritis (RA) have similar hospitalization outcomes than those without RA, but a higher cardiovascular risk.¹

“IBD and RA involve significant systemic inflammation and are driven by a complex interplay of genetic, environmental, and immune factors. Recent studies have noted that RA tends to occur frequently with IBD and patients with IBD have a higher risk of having RA.2 Given that both RA and IBD are progressive and disabling inflammatory diseases, their co-occurrence compromises the quality of life and prognosis for these patients,” lead investigator Sajana Poudel, MD, John H Stroger Jr Hospital Of Cook County, and colleagues wrote.¹

Poudel and colleagues conducted a retrospective observational study analyzing data from patients 18 years and older with a primary discharge diagnosis of IBD from the National Inpatient Sample (NIS) database from 2016 to 2020. Patients were stratified according to the presence or absence of RA and the investigators primarily looked at mortality rates, hospital length of stay (LOS), and total hospital charges. They also looked at the prevalence of comorbidities and IBD-related complications.

All told, the investigators identified 455,655 patientswith hospitalized IBD, 10,590 (2.32%) of whom had an underlying diagnosis of RA. Patients with both IBD and RA had a mean age of 52.21 years compared with a mean age of 45.72 years in those without RA (P <.001) and also had a higher proportion of females (72.51% vs. 53.27%, P < .01).¹

Poudel and colleagues found that patients with RA had a higher risk of cardiovascular risk factors than those without RA with diabetes (adjusted odd ratio [aOR], 1.12 [95% CI, 1.09-1.16]), hypertension (aOR, 1.19 [95% CI, 1.07-1.33]), hyperlipidemia (aOR, 1.61 [95% CI,1.60-1.63]), chronic kidney disease stage 1-4 (aOR, 1.35 [95% CI, 1.29-1.41]), coronary artery disease (aOR, 1.67 [95% CI, 1.65-1.69]), and heart failure (aOR, 1.45 [95% CI, 1.43-1.48]). Patients with RA had a significantly increased risk of acute kidney injury (OR, 1.68 [95% CI, 1.03-2.72]) compared to those without RA.1

Investigators found no significant differences in the rates of IBD-related complications or in-hospital mortality (OR 1.74, 95% CI: 0.95-3.19) between patients with or without RA. Patients with RA had a mean hospital length of stay of 5.15 days compared with 4.95 days for patients without RA (P = .08) and had similar total hospital charges ($48,442.7 vs. $48,720.3; P = .88). There were no significant risk differences between cardiovascular outcomes such as cardiac arrest, myocardial infarction, and septic shock, or intestinal complications such as Clostridium difficile infection, toxic megacolon, intestinal obstruction, and peritonitis.¹

“IBD patients with RA present a distinct and more complex health profile characterized by older age, female predominance, and a higher burden of comorbidities like cardiovascular diseases and metabolic conditions. Enhanced awareness among healthcare providers about the higher risk of comorbidities in IBD patients with RA is crucial. It is important to curate a multidisciplinary management approach to address the unique healthcare needs of this population,” Sajana and colleagues concluded.¹

“Comprehensive management strategies might include regular screenings for cardiovascular conditions and patient education to promote lifestyle changes that can reduce inflammation and improve overall health. Longitudinal studies are essential to further investigate the causal relationships and long-term outcomes in IBD patients with RA, ultimately guiding more effective, personalized care for these patients.”

REFERENCES

1. Poudel S, Ghimire M, Shrestha K, et al. Impact of Rheumatoid Arthritis on Hospitalized Inflammatory Bowel Disease Patients: Study of Demographics, Clinical Characteristics and Outcomes. Cureus. 2024;16(7):e65011. doi:10.7759/cureus.65011
2. The risk of rheumatoid arthritis among patients with inflammatory bowel disease: a systematic review and meta-analysis. Chen Y, Chen L, Xing C, et al. BMC Gastroenterol. 2020;20:192