Abstract
The purpose of this longitudinal follow-up study was to investigate the risk of ischemic stroke nationwide in patients with seropositive rheumatoid arthritis (RA) and controls who were matched in age and sex. Patient data were collected from the National Health Insurance Service (NHIS) Health Screening (HEALS) cohort. Using the International Classification of Diseases code M05 (seropositive RA), with a prescription of any disease-modifying anti-rheumatic drug (DMARD), RA was identified. A total of 2,765 patients and 13,825 control subjects were included in our study. The 12-year incidence of ischemic stroke in each group was calculated using the Kaplan-Meier method. The risk ratio of ischemic stroke was estimated using Cox proportional hazards regression. Sixty-four patients (2.31%) in the seropositive RA group and 512 (3.70%) in the control group experienced ischemic stroke (P < 0.001) during the follow-up period. The hazard ratio of ischemic stroke in the seropositive RA group was 1.32 (95% confidence interval (CI), 1.02-1.73) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in the seropositive RA group was 1.40 (95% CI, 1.07-1.82) after adjusting for demographics and comorbid medical disorders. According to the subgroup analysis, the hazard ratios of ischemic stroke risks in the female and hypertensive subgroups were 1.44 (95% CI, 1.05-1.97) and 1.66 (95% CI, 1.16-2.38), respectively. In the non-diabetes and non-dyslipidemia subgroups, the corresponding hazard ratios of ischemic stroke were 1.47 (95% CI, 1.11-1.95) and 1.43 (95% CI, 1.07-1.91). Seropositive RA patients have an increased risk of ischemic stroke. In female, hypertension, non-diabetes, and non-dyslipidemia RA subgroups, even without the traditional risk factors for stroke (except for hypertension), increased the risk, which could be potentially attributed to RA.
Highlights
Rheumatoid arthritis (RA) is a chronic, systemic, immune-mediated inflammatory disorder that induces dysfunction [1] and premature mortality [2,3,4]
A few studies reported a higher incidence of ischemic stroke among patients with RA [10, 12,13,14], whereas others have reported no link between the two factors [11, 15, 16]
The newly diagnosed seropositive RA patients (2,765) who were prescribed with disease-modifying anti-rheumatic drugs (DMARDs) during the study period were mostly females (73.4%), with a mean age of 54 ± 8.7 years
Summary
Rheumatoid arthritis (RA) is a chronic, systemic, immune-mediated inflammatory disorder that induces dysfunction [1] and premature mortality [2,3,4]. A few studies reported a higher incidence of ischemic stroke among patients with RA [10, 12,13,14], whereas others have reported no link between the two factors [11, 15, 16]. Some studies reported increased mortality rates, whereas others reported no differences [6, 17,18,19,20,21]. These contradictory results pertaining to ischemic stroke have been uncovered in RA and in other inflammatory diseases, such as ankylosing spondylitis [22,23,24]
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