December 05, 2019
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RA increases risk for CV disease, sleep apnea, venous thromboembolism

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Vanessa L. Kronzer

Patients with inflammatory bowel disease, type 1 diabetes and venous thromboembolism have an increased risk for rheumatoid arthritis, which in turn increases the risk for cardiovascular disease, obstructive sleep apnea and — again — venous thromboembolism, according to data published in Mayo Clinic Proceedings.

“Most existing studies of comorbidities in rheumatoid arthritis have been cross sectional, at one point in time,” Vanessa L. Kronzer, MD, of the Mayo Clinic told Healio Rheumatology. “In contrast, our study was able to distinguish when comorbidities develop relative to rheumatoid arthritis. We were also fortunate to be able to adjust for many important confounders such as smoking, which prior studies were not able to do.”

To determine the prevalence of comorbidities in RA, find which comorbidities may increase the risk for RA, and identify which comorbidities are more likely to develop after an RA diagnosis, Kronzer and colleagues conducted a case-control study of the Mayo Clinic’s biobank, which includes 55,898 participants and data on 74 comorbidities and their age of onset. The researchers included 821 adults with RA who were diagnosed at Mayo Clinics in Minnesota and Florida between January 2009 and February 2018. They also recruited 2,455 control participants without RA.

The researchers matched each patient with RA to three controls based on age and sex. Participants self-reported the development and presence of the onset of various comorbidities. Kronzer and colleagues used logistic regression models to evaluate the findings, adjusting for race, BMI, education, smoking and Charlson comorbidity index.

aerial view of blood flow in a clogged artery, Shutterstock 
Patients with inflammatory bowel disease, type 1 diabetes and venous thromboembolism have an increased risk for RA, which in turn increases the risk for cardiovascular disease, obstructive sleep apnea and venous thromboembolism, according to data.
Source: Shutterstock

According to the researchers, 11 comorbidities were associated with RA, including epilepsy (OR = 2.13; P = .009), obstructive sleep apnea (OR = 1.49; P = .001) and pulmonary fibrosis (OR = 4.63; P < .001). Patients more often demonstrated inflammatory bowel disease (OR = 3.82; P < .001), type 1 diabetes (OR = 3.07; P = .01) and venous thromboembolism (OR = 1.8; P < .001) prior to an RA diagnosis, compared with controls.

Myocardial infarction (OR = 3.09; P < .001) and venous thromboembolism (OR = 1.84; P < .001) occurred more often following a diagnosis of RA, compared with controls.

“The excess comorbidity burden that occurs in patients with RA occurs primarily after RA diagnosis,” Kronzer said. “Second, several diseases suggest an increased risk to develop RA, including autoimmune diseases such as inflammatory bowel disease and type 1 diabetes, along with venous thromboembolism. Third, several diseases occur more often after RA compared to controls including heart disease, VTE, and sleep apnea.”

She added, “based on these findings, people who have certain diseases such as IBD, type 1 diabetes or VTE should be aware that they may be at increased risk for RA. This may be particularly relevant for family members who are wondering if they might develop RA too. Another important implication of our study is that RA patients and their providers should have a high index of suspicion and low threshold to screen for heart disease, VTE and sleep apnea.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.