Rheumatoid arthritis

Risk of venous thromboembolism doubled in people with rheumatic diseases

People living with rheumatic and musculoskeletal diseases – especially rheumatoid arthritis – appear to be at greater risk of experiencing venous thromboembolism (VTE), researchers reported at the virtual meeting of the European League Against Rheumatism.

The risk is about twice that of patients who do not have active disease, but disease-modifying treatments may be able to attenuate that risk, suggested Professor John Isaacs, EULAR Scientific Committee Chair and a Professor of Clinical Rheumatology and an Honorary Consultant Rheumatologist with the Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.

At a press briefing, Isaacs described two studies:

A  large study from Sweden’s Karolinska University showed that the higher the Disease Activity Score (DAS28) the higher the risk of VTE.  Viktor Molander, a PhD student, and colleagues analysed data from 46,311 patients diagnosed with rheumatoid arthritis from the Swedish Rheumatology Quality Register (SRQ) over a 12-year period. The researchers concluded that “among patients with high disease activity, 1 in 100 is going to develop VTE within the following year, a more than two-fold increase compared to patients in remission.“

–In the so-called RABBIT [Rheumatoide Arthritis: Beobachtung der BiologikaTherapie] Register which included outcomes among 10,000 individuals, German researchers suggested this increased risk of thrombosis can be reduced by treatment with biological disease-modifying anti-rheutmatic drugs. The risk of thrombosis was reduced by half if the patients were taking the biologicals such as adalimumab, etanercept or infliximab and others when compared with patients who were using conventional synthetic disease-modifying anti-rheumatic drugs such as methotrexate, sulfasalazine and leflunomide.

In his comments at the press conference, Isaacs suggested that many people don’t look at rheumatoid arthritis as a disease that causes things like heart attacks or strokes, but in fact, it does. “A person with a rheumatoid disease loses on average about 7 years of life due to their disease,” he said. “Patients with rheumatoid arthritis have more heart attacks, they get more strokes, they die of severe infections.” And, he said, these studies show they get more VTEs.

“We’ve known for a while as rheumatologists that venous thromboembolism is more common in rheumatoid arthritis, at least three times more commonly depending on your age and other factors,” he said.  “We know we need to control their disease because it makes them feel better from the point of view of their joints. And we now know that it has a very important effect for example, on things like venous thromboembolism.”

He said that the German study indicates that the biologics “are probably more effective than conventional synthetic drugs, possibly because they’re better in reducing  inflammation. “Interestingly, the RABBIT study also confirm the doubling of the risk to patients with increased disease activity,” Isaacs said. “It also showed that you’re over 65 you have 3 times as the former to experience VTE. And actually if you’re more physically active, as you might expect, you have a lower risk.”

Press conference moderator, Robert Landewe, MD, professor of medicine at the University of Amsterdam, also suggested the information on reducing risk of VTE is especially important in the era of the COVID19 pandemic. That virus is also linked to abnormal blood clotting, he said.

“Having regular check-ups by a rheumatologist can be inconvenient,” Isaacs said. “However, it is an important measure to monitor the development of the condition and whether treatment has to be adjusted accordingly.”

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