Shin Alicia, Kang Seonyoung, Jung Jin-Hyung, Cho In Young, Han Kyung-Do, Kim Seonghye, Kim Se Yun, Shin Dong Wook, Kim Hyungjin
University of California, Los Angeles, USA.
Division of Rheumatology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Int J Stroke. 2025 Aug 30:17474930251377174. doi: 10.1177/17474930251377174.
Rheumatoid arthritis (RA) has been associated with an increased stroke risk, but associations by serostatus (seropositive RA (SPRA) vs. seronegative RA (SNRA)) and with subtypes of stroke (ischemic stroke (IS) or hemorrhagic stroke (HS)) are not well established. In addition, it is not well-known whether the use of biologic and targeted synthetic disease modifying anti-rheumatic drugs (b/tsDMARDs) are associated with altered stroke risk.
This nationwide cohort study used the Korean National Health Insurance Service database and included participants who were first diagnosed with RA in 2010-2017 with no previous history of stroke, and who had a health checkup within 2 years before the index date (45,175 RA patients). They were compared ( 1:3 ratio) with non-RA controls matched by age and sex (135,525 non-RA controls).
Patients with RA had significantly higher risk of both IS (aHR 1.47, 95% CI 1.36-1.58) and HS (aHR 1.31, 95% CI 1.15-1.50) compared to controls. SPRA patients showed higher risk for both IS (aHR 1.56, 95% CI 1.43-1.69 SPRA vs. aHR 1.23, 1.08-1.41 SNRA) and HS (aHR 1.40, 95% CI 1.21-1.62 SPRA vs. aHR 1.09, 95% CI 0.86-1.38 SNRA). No difference in stroke risk was observed between bDMARDs users and non-users (aHR 1.66 for users, aHR 1.41 for non-users). However, potential differences were noted with tsDMARDs use (aHR 0.81 for users vs. aHR 1.43 for non-users), although not statistically significant.
Patients with RA are at significantly greater risk for both IS and HS compared to those without RA and that SPRA patients showed higher risk than SNRA patients. Further studies are required to determine the potential of tsDMARDs in the prevention of stroke in RA.
类风湿关节炎（RA）与中风风险增加有关，但血清学状态（血清阳性RA（SPRA）与血清阴性RA（SNRA））与中风亚型（缺血性中风（IS）或出血性中风（HS））之间的关联尚未明确。此外，生物制剂和靶向合成改善病情抗风湿药物（b/tsDMARDs）的使用是否与中风风险改变相关也尚不明确。
这项全国性队列研究使用了韩国国民健康保险服务数据库，纳入了2010 - 2017年首次诊断为RA且既往无中风病史、在索引日期前2年内进行过健康检查的参与者（45175例RA患者）。将他们与按年龄和性别匹配的非RA对照者（135525例非RA对照者）进行比较（比例为1:3）。
与对照组相比，RA患者发生IS（调整后风险比[aHR] 1.47，95%置信区间[CI] 1.36 - 1.58）和HS（aHR 1.31，95% CI 1.15 - 1.50）的风险显著更高。SPRA患者发生IS（aHR 1.56，95% CI 1.43 - 1.69，SPRA组对比aHR 1.23，1.08 - 1.41，SNRA组）和HS（aHR 1.40，95% CI 1.21 - 1.62，SPRA组对比aHR 1.09，95% CI 0.86 - 1.38，SNRA组）的风险更高。使用bDMARDs者和未使用者之间未观察到中风风险差异（使用者aHR 1.66，未使用者aHR 1.41）。然而，使用tsDMARDs存在潜在差异（使用者aHR 0.81，未使用者aHR 1.43），尽管无统计学意义。
与无RA者相比，RA患者发生IS和HS的风险显著更高，且SPRA患者的风险高于SNRA患者。需要进一步研究以确定tsDMARDs在预防RA患者中风方面的潜力。
