Risk for VTE Elevated in Rheumatoid Arthritis

TOPLINE:

Patients with rheumatoid arthritis (RA) had a 46% higher risk for venous thromboembolism (VTE) than matched control individuals, with an elevated risk persisting across all age groups, BMI categories, and disease durations.

METHODOLOGY:

• Researchers conducted a matched cohort study to assess the risk for VTE in individuals with RA and to examine how the risk varied according to demographic and clinical factors.
• They included 23,410 patients with RA (mean age, 59.0 years; 71.1% women; mean BMI, 27.1) having no history of VTE and 93,640 matched control individuals who were registered with a UK general practice between 1999 and 2018.
• The primary outcome was the diagnosis of VTE, including deep venous thrombosis and pulmonary embolism as composite outcomes, using diagnostic codes, with an average follow-up duration of 8.2 years.

TAKEAWAY:

• Overall, 845 and 2020 VTE events were noted in patients with RA and matched control individuals, respectively.
• Patients with RA had a higher risk for VTE than matched control individuals (adjusted hazard ratio [aHR], 1.46; P < .001), with a higher relative excess risk seen in both men (aHR, 1.62; P < .001) and women (aHR, 1.52; P < .001).
• Younger patients aged 18-49 years with RA had the highest relative excess risk for VTE (aHR, 2.13) compared with those aged 50-69 years (aHR, 1.57) and those aged 70 years or older (aHR, 1.34; P < .001 for all).
• Compared with matched control individuals, the relative excess risk for VTE was highest among patients with RA having normal BMI (< 25; aHR, 1.66 vs 1.60 for those having BMI 25-30 and 1.41 for those having BMI > 30; P < .001 for all). The risk for VTE remained elevated regardless of disease duration.

IN PRACTICE:

“The excess risk of VTE is apparent within 2 years of disease onset, and is relatively more marked among younger individuals with RA when compared with individuals without RA. This has important clinical implications, and highlights the need to consider VTE risk in all patients diagnosed with RA,” the authors wrote.

SOURCE:

This study was led by Mark D. Russell, Centre for Rheumatic Diseases, King’s College London, London, England. It was published online on August 07, 2025, in Rheumatology.

LIMITATIONS:

This study utilised routinely collected data from primary care in the UK, potentially limiting generalisability. Data on disease activity and inflammation burden were not available, and data on immunosuppressant medications were only from primary care prescriptions. Unmeasured confounding and diagnostic misclassification related to the reliance on routinely collected healthcare data may have existed.

DISCLOSURES:

This study was sponsored by Pfizer, with some authors being current or former employees of Pfizer. Several authors reported having financial relationships with various pharmaceutical companies, including Pfizer, AbbVie, Galapagos, and Johnson & Johnson. One author reported being a co-editor for Rheumatology but has not peer reviewed or made any editorial decisions related to this study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.