Risk of venous thromboembolism in people with rheumatoid arthritis: a population-based study in the UK

Abstract

Objectives: To evaluate the absolute and relative risk of venous thromboembolism (VTE) in individuals with rheumatoid arthritis (RA), with relation to age, sex, body mass index (BMI), disease duration, and exposure to exogenous oestrogens.

Methods: Individuals with RA, registered with the UK Oxford-RCGP RSC primary care database between 1999-2018, were matched 1:4 with individuals without RA. Multivariable-adjusted Cox proportional hazards was used to compare VTE risk, stratified by age, sex, BMI, disease duration, and prescription of oestrogen-containing contraceptives or hormone-replacement therapy (HRT).

Results: VTE risk was higher in individuals with RA (n = 23,410) than matched controls (n = 93,640): adjusted hazard ratio 1.46 (95% CI 1.36, 1.56). Absolute risk of VTE increased with age and higher BMI. Compared with controls, however, the relative excess risk of VTE was higher in younger than older individuals: 18-49 years (2.13; 95% CI 1.62, 2.79); 50-69 years (1.57; 95% CI 1.38, 1.78); ≥70 years (1.34; 95% CI 1.14, 1.60); and higher in individuals with normal vs. elevated BMI: <25 kg/m2 (1.66; 95% CI 1.39, 1.98); 25-30 kg/m2 (1.60; 95% CI 1.36, 1.88); >30 kg/m2 (1.41; 95% CI 1.19, 1.68). VTE risk remained elevated irrespective of disease duration; was similar between women prescribed vs. not prescribed oestrogen-containing contraceptives; and higher for women prescribed HRT than those not prescribed HRT.

Conclusion: Individuals with RA are at increased risk of VTE regardless of age, sex, BMI, disease duration, and exposure to exogenous oestrogens. This highlights the need to consider VTE risk in all individuals with RA.

Keywords: Rheumatoid arthritis; epidemiology; obesity; pulmonary embolism; safety; venous thromboembolism.