Abstract
IntroductionWe performed a meta-analysis to investigate the risk of deep vein thrombosis (DVT) and/or pulmonary embolisms (PEs) in patients with inflammatory arthritis, vasculitis and connective tissue diseases (CTDs) (systemic lupus erythematosus (SLE), Sjögren’s syndrome, inflammatory myositis and systemic sclerosis (SSc)).MethodsPubMed, Embase, the Cochrane databases and MEDLINE were searched to identify full-text English-language publications about adult patients with rheumatologic inflammatory diseases and venous thromboembolisms (VTEs). Data regarding rates of DVTs and PEs were extracted. Using random-effects models, pooled estimates for VTEs in individual and pooled diseases were compared with matched populations where possible. Studies were excluded if VTEs were described in the setting of pregnancy, postoperative outcomes or solely antiphospholipid antibody syndrome.ResultsMost of the 5,206 studies were excluded because they did not state the rate or incidence of VTEs. In total, 25 studies remained for analysis. Ten studies that included rheumatoid arthritis comprised an aggregate of 5,273,942 patients and 891,530,181 controls with a cumulative VTE incidence of 2.18% (95% confidence interval (CI): 1.82% to 2.54%) and an odds ratio of 2.23 (95% CI: 2.02 to 2.47) compared to age- and sex-matched populations. Ten studies comprised an aggregate of 54,697 SLE patients with a cumulative VTE incidence of 7.29% (95% CI: 5.82% to 8.75%). Four Sjögren’s syndrome studies comprising an aggregate of 25,100 patients demonstrated a cumulative VTE incidence of 2.18% (95% CI: 0.79% to 3.57%). Four studies of inflammatory myositis comprising an aggregate of 8,245 patients yielded a cumulative VTE incidence of 4.03% (95% CI: 2.38% to 5.67%). The SSc- and antineutrophil cytoplasmic antibody vasculitis–related cumulative VTE rates (four studies each) were 3.13% and 7.97%, respectively.ConclusionsThe inflammatory rheumatologic diseases studied were all associated with high rates of VTEs—more than three times higher than in the general population.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-014-0435-y) contains supplementary material, which is available to authorized users.
Highlights
We performed a meta-analysis to investigate the risk of deep vein thrombosis (DVT) and/or pulmonary embolisms (PEs) in patients with inflammatory arthritis, vasculitis and connective tissue diseases (CTDs) (systemic lupus erythematosus (SLE), Sjögren’s syndrome, inflammatory myositis and systemic sclerosis (SSc))
Most of the data in the literature reveal this concern in patients with rheumatoid arthritis (RA) and SLE, and the SLE studies are focused mostly on increased risks associated with positive antiphospholipid status rather than on the innate hypercoagulability nature of this inflammatory disease [8,10]
Search strategy We performed a literature search of English-language publications related to Venous thromboembolism (VTE), DVT and/or PE in patients with inflammatory arthritis, vasculitis and CTDs such as SLE, Sjögren’s syndrome, inflammatory myositis and systemic sclerosis
Summary
We performed a meta-analysis to investigate the risk of deep vein thrombosis (DVT) and/or pulmonary embolisms (PEs) in patients with inflammatory arthritis, vasculitis and connective tissue diseases (CTDs) (systemic lupus erythematosus (SLE), Sjögren’s syndrome, inflammatory myositis and systemic sclerosis (SSc)). Venous thromboembolism (VTE) is a vascular phenomenon that includes clinical entities such as deep vein thrombosis (DVT) and pulmonary embolism (PE). These venous coagulopathies usually occur in the setting of Virchow’s triad, which describes conditions in which thromboses develop as a consequence of stasis, endothelial injury and innate hypercoagulability [1,2]. It is Rheumatologic conditions are often inflammatory by nature. VTEs seem to be linked to disease activity and/or inflammation in many of the inflammatory rheumatologic diseases
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