RESEARCH - Cardiovascular, rheumatologic, and pharmacologic predictors of stroke in patients with RA

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Arthritis Rheum. 2008 Jul 30;59(8):1090-1096.

Cardiovascular, rheumatologic, and pharmacologic predictors of stroke

in patients with rheumatoid arthritis: A nested, case-control study.

Nadareishvili Z, Michaud K, Hallenbeck JM, Wolfe F.

town University Hospital, Washington, DC.

OBJECTIVE: To determine the risk of stroke in patients with rheumatoid

arthritis (RA) and risk factors associated with stroke. METHODS: We

performed nested case-control analyses within a longitudinal databank,

matching up to 20 controls for age, sex, and time of cohort entry to

each patient with stroke. Conditional logistic regression was

performed as an estimate of the relative risk of stroke in RA patients

compared with those with noninflammatory rheumatic disorders, and to

examine severity and anti-tumor necrosis factor (anti-TNF) treatment

effects in RA. RESULTS: We identified 269 patients with first-ever

all-category strokes and 67 with ischemic stroke, including 41 in RA

patients. The odds ratio (OR) for the risk of all-category stroke in

RA was 1.64 (95% confidence interval [95% CI] 1.16-2.30, P = 0.005),

and for ischemic stroke was 2.66 (95% CI 1.24-5.70, P = 0.012).

Ischemic stroke was predicted by hypertension, myocardial infarction,

low-dose aspirin, comorbidity score, Health Assessment Questionnaire

score, and presence of total joint replacement, but not by diabetes,

smoking, exercise, or body mass index. Adjusted for cardiovascular and

RA risk factors, ischemic stroke was associated with rofecoxib (P =

0.060, OR 2.27 [95% CI 0.97-5.28]), and possibly with corticosteroid

use. Anti-TNF therapy was not associated with ischemic stroke (P =

0.584, OR 0.80 [95% CI 0.34-1.82]).

CONCLUSION: RA is associated with increased risk of stroke,

particularly ischemic stroke. Stroke is predicted by RA severity,

certain cardiovascular risk factors, and comorbidity. Except for

rofecoxib, RA treatment does not appear to be associated with stroke,

although the effect of corticosteroids remains uncertain.

PMID: 18668583

http://www.ncbi.nlm.nih.gov/pubmed/18668583

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