Dr. Wolfe has received consultant fees (less than $10,000) from Bristol-Myers Squibb.
Cardiovascular, rheumatologic, and pharmacologic predictors of stroke in patients with rheumatoid arthritis: A nested, case–control study†
Article first published online: 30 JUL 2008
Copyright © 2008 by the American College of Rheumatology
Arthritis Care & Research
Volume 59, Issue 8, pages 1090–1096, 15 August 2008
How to Cite
Nadareishvili, Z., Michaud, K., Hallenbeck, J. M. and Wolfe, F. (2008), Cardiovascular, rheumatologic, and pharmacologic predictors of stroke in patients with rheumatoid arthritis: A nested, case–control study. Arthritis & Rheumatism, 59: 1090–1096. doi: 10.1002/art.23935
The National Data Bank for Rheumatic Diseases has conducted safety registries for Centocor, Sanofi-Aventis, and Bristol-Myers Squibb, and has received research grants from Abbott, Amgen, Wyeth-Australia, Merck, and Pfizer.
- Issue published online: 30 JUL 2008
- Article first published online: 30 JUL 2008
- Manuscript Accepted: 28 JAN 2008
- Manuscript Received: 9 SEP 2007
To determine the risk of stroke in patients with rheumatoid arthritis (RA) and risk factors associated with stroke.
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.
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]).
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.