Section of Rheumatology, Boston University School of Medicine, Boston, MA 02118, USA.
Ann Rheum Dis. 2013 Jul;72(7):1182-7. doi: 10.1136/annrheumdis-2012-201669. Epub 2012 Aug 28.
Recent hospital-based studies have suggested a sixfold increased risk of pulmonary embolism (PE) in rheumatoid arthritis (RA) in the year following admission. We evaluated the risk of PE and deep vein thrombosis (DVT) and associated time trend among RA patients (84.5% without a history of hospitalisation during the past year) derived from the general population.
We conducted a cohort study using an electronic medical records database representative of the UK general population, collected from 1986 to 2010. Primary definitions of the RA cohort (exposure) and PE/DVT outcomes required physician diagnoses followed by corresponding treatments. We estimated relative risks (RRs) of PE and DVT compared with a matched non-RA comparison cohort, adjusting for age, sex, smoking, body mass index, comorbidities and hospitalisations.
Among 9589 individuals with RA (69% female, mean age of 58 years), 82 developed PE and 110 developed DVT (incidence rates, 1.5 and 2.1 per 1000 person-years). Compared with non-RA individuals (N=95 776), the age-, sex- and entry-time-matched RRs were 2.23 (95% CI 1.75 to 2.86) for PE and 2.20 (CI 1.78 to 2.71) for DVT. Adjusting for other covariates, the corresponding RRs were 2.16 (CI 1.68 to 2.79) and 2.16 (CI 1.74 to 2.69). The time-specific RRs for PE were 3.27, 1.88 and 2.35 for follow-up times of <1 year, 1-4.9 years, and ≥5 years, and corresponding RRs for DVT were 3.16, 1.82 and 2.32.
This population-based study indicates an increased risk of PE and DVT in RA, supporting increased monitoring of venous-thromboembolic complications and risk factors in RA, regardless of hospitalisation.
最近的基于医院的研究表明，在入院后一年内，类风湿关节炎（RA）患者发生肺栓塞（PE）的风险增加了六倍。我们评估了来自普通人群的 RA 患者（84.5%在过去一年中没有住院史）中 PE 和深静脉血栓形成（DVT）的风险以及相关的时间趋势。
我们使用从 1986 年至 2010 年收集的代表英国普通人群的电子病历数据库进行了队列研究。RA 队列（暴露）和 PE/DVT 结果的主要定义需要医生诊断，随后需要相应的治疗。我们估计了与匹配的非 RA 对照组相比，PE 和 DVT 的相对风险（RR），调整了年龄、性别、吸烟、体重指数、合并症和住院情况。
在 9589 名 RA 患者（69%为女性，平均年龄为 58 岁）中，有 82 人发生了 PE，110 人发生了 DVT（发病率分别为 1.5 和 2.1/1000 人年）。与非 RA 个体（N=95776）相比，年龄、性别和入组时间匹配的 RR 分别为 2.23（95%CI 1.75 至 2.86）用于 PE 和 2.20（CI 1.78 至 2.71）用于 DVT。调整其他协变量后，相应的 RR 分别为 2.16（CI 1.68 至 2.79）和 2.16（CI 1.74 至 2.69）。PE 的时间特异性 RR 分别为<1 年、1-4.9 年和≥5 年随访时间的 3.27、1.88 和 2.35，相应的 DVT RR 分别为 3.16、1.82 和 2.32。
这项基于人群的研究表明 RA 患者发生 PE 和 DVT 的风险增加，支持无论是否住院，RA 患者都应加强静脉血栓栓塞并发症和危险因素的监测。
