Serious adverse events and the risk of stroke in patients with rheumatoid arthritis: results from the German RABBIT cohort

Meissner Y, Richter A, Manger B, Tony HP, Wilden E, Listing J, Zink A, Strangfeld A (2017)

Publication Type: Journal article

Publication year: 2017

Journal

Annals of the Rheumatic Diseases BMJ Publishing Group

DOI: 10.1136/annrheumdis-2017-211209

Abstract

In the general population, the incidence of stroke is increased following other serious events and hospitalisation. We investigated the impact of serious adverse events on the risk of stroke in patients with rheumatoid arthritis (RA), taking risk factors and treatment into account.Using data of the German biologics register RABBIT (Rheumatoid Arthritis: Observation of Biologic Therapy) with 12354 patients with RA, incidence rates (IRs) and risk factors for stroke were investigated using multi-state and Cox proportional hazard models. In addition, in a nested case-control study, all patients with stroke were matched 1:2 to patients with identical baseline risk profile and analysed using a shared frailty model.During follow-up, 166 strokes were reported. The overall IR was 3.2/1000 patient-years (PY) (95% CI 2.7 to 3.7). It was higher after a serious adverse event (IR: 9.0 (7.3 to 11.0)), particularly within 30 days after the event (IR: 94.9 (72.6 to 121.9)). The adjusted Cox model showed increased risks of age per 5 years (HR: 1.4 (1.3 to 1.5)), hyperlipoproteinaemia (HR: 1.6 (1.0 to 2.5)) and smoking (HR: 1.9 (1.3 to 2.6)). The risk decreased with better physical function (HR: 0.9 (0.8 to 0.96)).In the case-control study, 163 patients were matched to 326 controls. Major risk factors for stroke were untreated cardiovascular disease (HR: 3.3 (1.5 to 7.2)) and serious infections (HR:4.4 (1.6 to 12.5)) or other serious adverse events (HR: 2.6 (1.4 to 4.8)).Incident adverse events, in particular serious infections, and insufficient treatment of cardiovascular diseases are independent drivers of the risk of stroke. Physicians should be aware that patients who experience a serious event are at increased risk of subsequent stroke.

Authors with CRIS profile

Bernhard Manger Professur für Rheumatologie und Klinische Immunologie

Involved external institutions

Deutsches Rheuma-Forschungszentrum (DRFZ) DE Germany (DE) Julius-Maximilians-Universität Würzburg DE Germany (DE)

How to cite

APA:

Meissner, Y., Richter, A., Manger, B., Tony, H.P., Wilden, E., Listing, J.,... Strangfeld, A. (2017). Serious adverse events and the risk of stroke in patients with rheumatoid arthritis: results from the German RABBIT cohort. Annals of the Rheumatic Diseases. https://doi.org/10.1136/annrheumdis-2017-211209

MLA:

Meissner, Y., et al. "Serious adverse events and the risk of stroke in patients with rheumatoid arthritis: results from the German RABBIT cohort." Annals of the Rheumatic Diseases (2017).

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