Rheumatoid arthritis significantly increased recurrence risk after ischemic stroke/transient ischemic attack

Chen, Yih Ru; Hsieh, Fang I.; Lien, Li Ming; Hu, Chaur Jong; Jeng, Jiann‐Shing; Peng, Giia Sheun; Tang, Sung‐Chun; Fang, Nai; Sung, Yueh Feng; Chiou, Hung Yi

doi:10.1007/s00415-018-8885-9

Cited by 17 publications

(11 citation statements)

References 42 publications

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“…[23] The risk of recurrent stroke was also higher in RA patients. [24] Because the relationship between RA and cerebrovascular diseases has been thoroughly evaluated in previous investigations, this topic was not the primary focus of the present study. Instead, we compared the stroke risk among different levels of RA disease severity.…”

Section: Discussionmentioning

confidence: 99%

The impact of rehabilitation frequency on the risk of stroke in patients with rheumatoid arthritis

Cheng

Chang

Kao³

et al. 2020

PLoS ONE

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Background Patients with rheumatoid arthritis are at higher risk of developing stroke due to augmented systemic inflammation. While regular exercise has been shown to reduce inflammation in human subjects, the purpose of our study is to determine whether increased frequency of rehabilitation is protective against stroke or not. Methods A total of 16,224 rheumatoid arthritis patients with a catastrophic illness certificate were identified in our database from 2000 to 2006, and 663 of them developed stroke before the end of 2013. After statistically matching for age, sex, and the time interval between the diagnosis of rheumatoid arthritis and stroke, 642 patients without stroke were identified as the control group. Analyses with Student's t test and Chi-square test were done to compare the clinical characteristics of patients with and without stroke, and logistic regression analysis was then performed to evaluate the odds ratio of stroke. Results Higher odds ratio of stroke was revealed in patients with hypertension, diabetes mellitus, and moderate degree of rheumatoid arthritis disease severity. Furthermore, more than 40 rehabilitation sessions per year reduced the risk of developing stroke in patients with moderate disease severity. Conclusions Physical activities brought by more rehabilitation sessions are beneficial and should be encouraged in patients with rheumatoid arthritis, particularly for those with higher disease activity but not taking biologic agents.

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Section: Discussionmentioning

confidence: 99%

The impact of rehabilitation frequency on the risk of stroke in patients with rheumatoid arthritis

Cheng

Chang

Kao³

et al. 2020

PLoS ONE

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“…In a large Chen et al [40] study involving 3,190 pa tients after a stroke or transient ischemic attack, 638 patients were also diagnosed with RA and 2,552 strokes were reported in patients without RA. In patients with no RA, the quoted authors showed significantly less fre quent recurrence of strokes or transient ischemic attacks.…”

Section: Reumatologia 2020; 58/5mentioning

confidence: 99%

The importance of homocysteine in the development of cardiovascular complications in patients with rheumatoid arthritis

et al. 2020

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Rheumatoid arthritis (RA) not only leads to disability due to joint changes, but also significantly shortens the life expectancy of patients, mainly due to more frequent occurrence of heart attacks and strokes. Accelerated atherosclerosis in these patients is caused, among other factors, by high homocysteine (HCY) concentration in blood. Numerous studies have shown that treatment with vitamin B significantly reduces the concentration of HCY in blood, but does not reduce the risk of heart diseases. Recent studies have shown, however, that folic acid (FA) administration reduces the risk of stroke by 10–20%. Due to the fact that in patients with RA strokes are more frequent than in the general population and hyperhomocysteinemia (HHCY) is often found, determination of HCY concentration in blood is advisable, and in persons with HHCY it is recommended to use FA in primary and secondary stroke prevention.

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“…Patients were followed until first occurrence of ischemic stroke (ICD-9-CM codes 433.x1, 434 (excluding 434.x0), 435, and 436), [28,29] or the last available date in the database. The longest follow-up duration was up to 10 years.…”

Section: Outcome Measurement and Comorbiditiesmentioning

confidence: 99%

Predicting the Risk of Ischemic Stroke among Patients with Rheumatoid Arthritis Using a Simplified RA-CHADSV Score Based on the CHA2DS2-VASc Score

Hsu

et al. 2020

Medicina

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Background and Objectives: The aim of this retrospective cohort study was to develop a new score (RA-CHADSV) (rheumatoid arthritis - congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, and vascular disease), modified from the CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, stroke/transient ischemic attack (doubled), vascular disease, age 65–74 years, and female), in predicting the risk of ischemic stroke in rheumatoid arthritis (RA) patients without atrial fibrillation (AF). Materials and Methods: Using the Taiwan’s National Health Insurance Research Database, 592 patients with RA diagnosed between 2000 and 2002 were identified and followed until first occurrence of ischemic stroke or the last available date in the database. Incidence rate ratios (IRR) of ischemic stroke for the CHA2DS2-VASc score were calculated using Poisson regression models. A new prediction score RA-CHADSV was developed using multiple logistic regression analysis with bootstrap validation. Results: The area under the receiver operating characteristic curve of the newly developed RA-CHADSV score and the CHA2DS2-VASc score were 0.73 (95% confidence interval (CI) 0.64–0.82) and 0.70 (95% CI 0.61–0.79), respectively. The RA-CHADSV score was significantly associated with a higher ischemic stroke incidence in the patients who scored ≥1 (adjusted IRR 7.39, p < 0.001). Conclusions: A simplified RA-CHADSV score, with comparable efficiency as the CHA2DS2-VASc score, but easier to use clinically was developed for predicting the risk of ischemic stroke among non-AF RA patients.

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Rheumatoid arthritis significantly increased recurrence risk after ischemic stroke/transient ischemic attack

Cited by 17 publications

References 42 publications

The impact of rehabilitation frequency on the risk of stroke in patients with rheumatoid arthritis

The impact of rehabilitation frequency on the risk of stroke in patients with rheumatoid arthritis

The importance of homocysteine in the development of cardiovascular complications in patients with rheumatoid arthritis

Predicting the Risk of Ischemic Stroke among Patients with Rheumatoid Arthritis Using a Simplified RA-CHADSV Score Based on the CHA2DS2-VASc Score

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