Risk of Stroke in Patients with Rheumatism: A Nationwide Longitudinal Population-based Study

Liou, Tsan Hon; Huang, Shih Wei; Lin, Jia Wei; Chang, Yu Sheng; Wu, Chin Wen; Lin, Hui Wen

doi:10.1038/srep05110

Cited by 54 publications

(52 citation statements)

References 42 publications

(43 reference statements)

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“…This mechanism is supported by the observation by Liou et al [9] that incidence of stroke was increased in patients with longer duration of systemic autoimmune disease. RA and atherosclerosis share many common inflammatory pathways, and the mechanisms leading to synovial inflammation are similar to those found in unstable atherosclerotic plaque [22][23][24].…”

Section: Pathogenesissupporting

confidence: 56%

“…In another large, nationwide, longitudinal population-based study of 6114 patients with RA, after adjustment for potential confounding factors, the adjusted hazard ratio (HR) of stroke (both ischemic and hemorrhagic types) was 1.24 (95 % CI 1.11 to 1.39), which was larger than those in the control group [9]. In the same cohort, compared to the control group, patients with RA were more likely to have comorbid hypertension (HTN), hyperlipidemia (HL), coronary artery disease (CAD), congestive heart failure (CHF), renal disease, and valvular heart disease (pG0.001 for all individually).…”

Section: Epidemiologymentioning

confidence: 89%

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Prevention of Stroke in Rheumatoid Arthritis

Dhillon

Liang

2015

Curr Treat Options Neurol

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Recognizing that systemic inflammation is a major contributor to the increased risk of cardiovascular disease (CVD), including stroke, in rheumatoid arthritis (RA) serves as the basis for prevention strategies for cerebrovascular disease in RA. In addition to traditional cardiovascular risk factors, recognize that RA may be an independent risk factor for cerebrovascular accident (CVA). The risk of CVD should be assessed in each patient with RA, utilizing modified risk score calculators. Careful monitoring and control of systemic inflammation should be undertaken in conjunction with assessing each patient's CVD risk, acknowledging the benefits and risks of specific RA-directed therapies. Emphasis should be given to early and aggressive control of inflammation in RA patients, particularly those with seropositivity, increased inflammatory markers, long disease duration (>10 years), and/or extra-articular manifestations. In RA patients requiring glucocorticoid therapy, attempts should be made to use or wean to the minimal effective dose (preferably less than 7.5 mg/day). It should be recognized that both disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, and tumor necrosis factor (TNF)-alpha inhibitors partially mitigate the risk of CVD. In patients with inadequate control of inflammation with DMARDs, consideration should be given to switch to anti-TNF agents earlier in the disease process. Modifiable risk factors should be addressed as per guidelines for the general population. Active RA may be considered as a risk equivalent to diabetes mellitus when applying these guidelines. With regard to lipid management and use of statin therapy, further studies are required given the apparent "lipid paradox" in RA. Use of aspirin for primary prevention in RA has not been well studied; however, when aspirin is used for secondary prevention, one should recognize that concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) may decrease the antiplatelet effect. Given the cardiovascular risk associated with NSAIDs, the lowest possible dose for the shortest time should be used.

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Section: Pathogenesissupporting

confidence: 56%

Section: Epidemiologymentioning

confidence: 89%

Prevention of Stroke in Rheumatoid Arthritis

Dhillon

Liang

2015

Curr Treat Options Neurol

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“…A unique and useful finding, that ST6GAL1/NEU1 ratio in SLE activated T-cells correlates with SLEDAI scores is supported by Liou et al, who found a similar correlation while studying SLE B-cells [157] . Although the correlation is unambiguous, it must be further investigated to obtain more data as the sample size was low (n=8) in this study.…”

Section: Discussionsupporting

confidence: 66%

Human immunosuppressive protein, galectin-1 emerges as a novel regulatory factor in autoimmune disorders

Hornung¹

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“…Antiphospholipid antibodies can cause a state of hypercoagulation in patients with SLE, thereby increasing the risk of stroke . In addition, our previous nationwide population‐based study revealed that patients with SLE have a 1.88‐fold increased risk of stroke . Luyendijk et al found that the deterioration of neural structures can be caused by cerebral microinfarction in patients with SLE .…”

Section: Discussionmentioning

confidence: 91%