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Clinical Rheumatology

, Volume 37, Issue 11, pp 2917–2926 | Cite as

Risk of adverse outcomes in patients with rheumatoid arthritis hospitalized for stroke—a cross-sectional study

  • Jiunn-Horng Kang
  • Sudha Xirasagar
  • Herng-Ching LinEmail author
  • Pai-Feng Kao
  • Li-Chin Sung
Original Article
  • 145 Downloads

Abstract

Specific data regarding the full range of stroke outcomes among patients with rheumatoid arthritis (RA) are lacking. This study aimed to investigate outcomes in RA patients hospitalized for a stroke. The study retrieved data from the Taiwan Longitudinal Health Insurance Database 2005. We identified 26,336 patients who were hospitalized for stroke treatment. Of these patients, 736 patients with a prior diagnosis of RA before the index hospitalization were selected as the study group. We selected 2208 age–sex-matched patients without RA as the comparison group. We performed conditional logistic regressions to calculate odds ratios (ORs) for in-hospital mortality and secondary diagnoses of pneumonia, urinary tract infections (UTIs), peptic ulcers, acute respiratory failure, and the use of mechanical ventilation to compare RA patients and comparison patients. We also compared the length of stay (LOS) and hospitalization costs between patients with RA and comparison patients. We found that RA patients had a significantly increased risk of peptic ulcer during the stroke hospitalization (OR = 1.52, 95% CI = 1.05–2.20). However, there were no significant differences between patients with RA and comparison patients in terms of in-hospital mortality, pneumonia, UTIs, acute respiratory failure, or the use of mechanical ventilation. Furthermore, the LOS of stroke hospitalization did not differ between the two groups. We concluded that RA patients hospitalized for a stroke do not have a significantly different risk of in-hospital mortality, pneumonia, UTIs, and mechanical ventilator use, but they have a higher risk of peptic ulcers. Additionally, among patients with a subarachnoid/intracerebral hemorrhagic stroke, RA patients were more likely to have received mechanical ventilation than comparison patients (adjusted OR = 1.89, 95% CI = 1.14–3.15).

Keywords

Cardiovascular risk Epidemiology Rheumatoid arthritis Stroke 

References

  1. 1.
    Mikuls TR (2003) Co-morbidity in rheumatoid arthritis. Best Pract Res Clin Rheumatol 17(5):729–752CrossRefPubMedGoogle Scholar
  2. 2.
    Gkaliagkousi E, Gavriilaki E, Doumas M, Petidis K, Aslanidis S, Stella D (2012) Cardiovascular risk in rheumatoid arthritis: pathogenesis, diagnosis, and management. J Clin Rheumatol 18(8):422–430CrossRefPubMedGoogle Scholar
  3. 3.
    Holmqvist M, Gransmark E, Mantel A, Alfredsson L, Jacobsson LT, Wallberg-Jonsson S (2013) Occurrence and relative risk of stroke in incident and prevalent contemporary rheumatoid arthritis. Ann Rheum Dis 72(4):541–546CrossRefPubMedGoogle Scholar
  4. 4.
    Takeshima Y, Matsuda R, Hironaka Y, Motoyama Y, Nakase H (2015) Rheumatoid arthritis-induced lateral atlantoaxial subluxation with multiple vertebrobasilar infarctions. Spine 40:E186–E189CrossRefPubMedGoogle Scholar
  5. 5.
    Spath NB, Amft N, Farquhar D (2014) Cerebral vasculitis in rheumatoid arthritis. QJM 107:1027–1029CrossRefPubMedGoogle Scholar
  6. 6.
    Lindhardsen J, Ahlehoff O, Gislason GH, Madsen OR, Olesen JB, Svendsen JH, Torp-Pedersen C, Hansen PR (2012) Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study. BMJ 344:e1257CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Wiseman SJ, Ralston SH, Wardlaw JM (2016) Cerebrovascular disease in rheumatic diseases: a systematic review and meta-analysis. Stroke 47(4):943–950CrossRefPubMedGoogle Scholar
  8. 8.
    Fransen J, Kazemi-Bajestani SM, Bredie SJ, Popa CD (2016) Rheumatoid arthritis disadvantages younger patients for cardiovascular diseases: a meta-analysis. PLoS One 11(6):e0157360CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Tanaka K, Hamada K, Nakayama T, Matsuda S, Atsumi A, Shimura T, Nemoto M (2016) Risk for cardiovascular disease in Japanese patients with rheumatoid arthritis: a large-scale epidemiological study using a healthcare database. Springerplus 5(1):1111CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Liou TH, Huang SW, Lin JW, Chang YS, Wu CW, Lin HW (2014) Risk of stroke in patients with rheumatism: a nationwide longitudinal population-based study. Sci Rep 4:5110CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Smith AM, Sperling JW, Cofield RH (2005) Outcomes are poor after treatment of sepsis in the rheumatoid shoulder. Clin Orthop Relat Res 439:68–73CrossRefPubMedGoogle Scholar
  12. 12.
    Steen KS, Lems WF, Aertsen J, Bezemer D, Dijkmans BA (2007) The impact of rheumatoid arthritis on rehabilitation outcomes after lower extremity arthroplasty. J Clin Rheumatol 13(5):247–250CrossRefGoogle Scholar
  13. 13.
    Kang JH, Hsieh MS, Lin HC (2010) Comparison of treatment outcomes following total knee arthroplasty among patients with rheumatoid arthritis and osteoarthritis: a nationwide population-based study. Rheumatology 49(7):1409–1410CrossRefPubMedGoogle Scholar
  14. 14.
    Soohoo NF, Farng E, Lieberman JR et al (2010) Factors that predict short-term complication rates after total hip arthroplasty. Clin Orthop Relat Res 468(9):2363–2371CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Godeau B, Mortier E, Roy PM, Chevret S, Bouachour G, Schlemmer B, Carlet J, Dhainaut JF, Chastang C (1997) Short and longterm outcomes for patients with systemic rheumatic diseases admitted to intensive care units: a prognostic study of 181 patients. J Rheumatol 24(7):1317–1323PubMedGoogle Scholar
  16. 16.
    Janssen NM, Karnad DR, Guntupalli KK (2002) Rheumatologic diseases in the intensive care unit: epidemiology, clinical approach, management, and outcome. Crit Care Clin 18(4):729–748CrossRefPubMedGoogle Scholar
  17. 17.
    Moreels M, Melot C, Leeman M (2005) Prognosis of patients with systemic rheumatic diseases admitted to the intensive care unit. Intensive Care Med 31(4):591–593CrossRefPubMedGoogle Scholar
  18. 18.
    Van Doornum S, Brand C, King B, Sundararajan V (2006) Increased case fatality rates following a first acute cardiovascular event in patients with rheumatoid arthritis. Arthritis Rheum 54(7):2061–2068CrossRefPubMedGoogle Scholar
  19. 19.
    Aviña-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D (2008) Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 59(12):1690–1697CrossRefPubMedGoogle Scholar
  20. 20.
    Huang CW, Saposnik G, Fang J, Steven DA, Burneo JG (2014) Influence of seizures on stroke outcomes: a large multicenter study. Neurology 82(9):768–776CrossRefPubMedGoogle Scholar
  21. 21.
    Camara-Lemarroy CR, Ibarra-Yruegas BE, Gongora-Rivera F (2014) Gastrointestinal complications after ischemic stroke. J Neurol Sci 346(1–2):20–25CrossRefPubMedGoogle Scholar
  22. 22.
    Chen YD, Li SJ, Sun FH, Liu YY, Hu WL (2011) Monitoring of medical complications after acute ischemic stroke in a neurological intensive care unit. Eur Neurol 66(4):204–209CrossRefPubMedGoogle Scholar
  23. 23.
    Crepaldi G, Scirè CA, Carrara G, Sakellariou G, Caporali R, Hmamouchi I, Dougados M, Montecucco C (2016) Cardiovascular comorbidities relate more than others with disease activity in rheumatoid arthritis. PLoS One 11(1):e0146991CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Liao KP, Liu J, Lu B, Solomon DH, Kim SC (2015) Association between lipid levels and major adverse cardiovascular events in rheumatoid arthritis compared to non-rheumatoid arthritis patients. Arthritis Rheum 67(8):2004–2010CrossRefGoogle Scholar
  25. 25.
    Mackey RH, Kuller LH, Moreland LW (2017) Cardiovascular disease risk in patients with rheumatic diseases. Clin Geriatr Med 33(1):105–117CrossRefPubMedGoogle Scholar
  26. 26.
    Ben-Zvi I, Goldenberg I, Matetzky S, Grossman C, Elis A, Gavrielov-Yusim N, Livneh A (2016) The impact of inflammatory rheumatic diseases on the presentation, severity, and outcome of acute coronary syndrome. Clin Rheumatol 35(1):233–237CrossRefPubMedGoogle Scholar
  27. 27.
    Varghese JJ, Koneru S, Scaife SL, Zahnd WE, Francis ML (2010) Mortality after coronary artery revascularization of patients with rheumatoid arthritis. J Thorac Cardiovasc Surg 140(1):91–96CrossRefPubMedGoogle Scholar
  28. 28.
    den Hertog HM, van Rossum JA, van der Worp HB, van Gemert HM, de Jonge R, Koudstaal PJ, Dippel DW, investigators PAIS (2009) C-reactive protein in the very early phase of acute ischemic stroke: association with poor outcome and death. J Neurol 256(12):2003–2008CrossRefGoogle Scholar
  29. 29.
    Rocco A, Ringleb PA, Grittner U, Nolte CH, Schneider A, Nagel S (2015) Follow-up C-reactive protein level is more strongly associated with outcome in stroke patients than admission levels. Neurol Sci 36(12):2235–2241CrossRefPubMedGoogle Scholar
  30. 30.
    Steen KS, Lems WF, Aertsen J, Bezemer D, Dijkmans BA (2001) Incidence of clinically manifest ulcers and their complications in patients with rheumatoid arthritis. Ann Rheum Dis 60(5):443–447CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Wolfe F, Hawley DJ (2000) The comparative risk and predictors of adverse gastrointestinal events in rheumatoid arthritis and osteoarthritis: a prospective 13 year study of 2131 patients. J Rheumatol 27(7):1668–1673PubMedGoogle Scholar
  32. 32.
    Ogata T, Kamouchi M, Matsuo R, Hata J, Kuroda J, Ago T, Sugimori H, Inoue T, Kitazono T, Fukuoka Stroke Registry (2014) Gastrointestinal bleeding in acute ischemic stroke: recent trends from the Fukuoka stroke registry. Cerebrovasc Dis Extra 4(2):156–164CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    ten Wolde S, Dijkmans BA, Janssen M, Hermans J, Lamers CB (1996) High-dose ranitidine for the prevention of recurrent peptic ulcer disease in rheumatoid arthritis patients taking NSAIDs. Aliment Pharmacol Ther 10(3):347–331CrossRefPubMedGoogle Scholar
  34. 34.
    Silverstein FE, Graham DY, Senior JR, Davies HW, Struthers BJ, Bittman RM, Geis GS (1995) Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 123(4):241–249CrossRefPubMedGoogle Scholar
  35. 35.
    Bianchi Porro G, Lazzaroni M, Imbesi V, Montrone F, Santagada T (2000) Efficacy of pantoprazole in the prevention of peptic ulcers, induced by non-steroidal anti-inflammatory drugs: a prospective, placebo-controlled, double-blind, parallel-group study. Dig Liver Dis 32(3):201–208CrossRefPubMedGoogle Scholar
  36. 36.
    Gerson LB (2013) Proton pump inhibitors and potential interactions with clopidogrel: an update. Curr Gastroenterol Rep 15(6):329CrossRefPubMedGoogle Scholar
  37. 37.
    Lahiri S, Mayer SA, Fink ME, Lord AS, Rosengart A, Mangat HS, Segal AZ, Claassen J, Kamel H (2015) Mechanical ventilation for acute stroke: a multi-state population-based study. Neurocrit Care 23(1):28–32CrossRefPubMedGoogle Scholar
  38. 38.
    Shaw M, Collins BF, Ho LA, Raghu G (2015) Rheumatoid arthritis-associated lung disease. Eur Respir Rev 24(135):1–16CrossRefPubMedGoogle Scholar
  39. 39.
    Svensson AL, Christensen R, Persson F, Løgstrup BB, Giraldi A, Graugaard C, Fredberg U, Blegvad J, Thygesen T, Hansen IM, Colic A, Bagdat D, Ahlquist P, Jensen HS, Hørslev-Petersen K, Sheetal E, Christensen TG, Svendsen L, Emmertsen H, Ellingsen T (2016) Multifactorial intervention to prevent cardiovascular disease in patients with early rheumatoid arthritis: protocol for a multicentre randomised controlled trial. BMJ Open 6(4):e009134CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Dhillon N, Liang K (2015) Prevention of stroke in rheumatoid arthritis. Curr Treat Options Neurol 17(7):356CrossRefPubMedGoogle Scholar
  41. 41.
    Sattin M, Towheed T (2016) The effect of TNFalpha-inhibitors on cardiovascular events in patients with rheumatoid arthritis: an updated systematic review of the literature. Curr Rheumatol Rev 12(3):208–222CrossRefPubMedGoogle Scholar
  42. 42.
    Kvien TK, Uhlig T, Ødegård S, Heiberg MS (2006) Epidemiological aspects of rheumatoid arthritis: the sex ratio. Ann N Y Acad Sci 1069:212–222CrossRefPubMedGoogle Scholar
  43. 43.
    Solomon DH, Reed GW, Kremer JM, Curtis JR, Farkouh ME, Harrold LR, Hochberg MC, Tsao P, Greenberg JD (2015) Disease activity in rheumatoid arthritis and the risk of cardiovascular events. Arthritis Rheum 67(6):1449–1455CrossRefGoogle Scholar
  44. 44.
    Nguyen-Oghalai TU, Wu H, McNearney TA, Granger CV, Ottenbacher KJ (2008) Functional outcome after stroke in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Rheum 59(7):984–988CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Kapral MK, Fang J, Alibhai SM, Cram P, Cheung AM, Casaubon LK, Prager M, Stamplecoski M, Rashkovan B, Austin PC (2017) Risk of fractures after stroke: results from the Ontario stroke registry. Neurology 88(1):57–64CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  1. 1.Department of Physical Medicine and RehabilitationTaipei Medical University HospitalTaipeiTaiwan
  2. 2.Department of Physical Medicine and Rehabilitation, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  3. 3.Department of Health Services Policy and Management, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  4. 4.School of Health Care AdministrationTaipei Medical UniversityTaipeiTaiwan
  5. 5.Sleep Research CenterTaipei Medical University HospitalTaipeiTaiwan
  6. 6.Department of Internal Medicine, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  7. 7.Division of Cardiology, Department of Internal Medicine, Shuang Ho HospitalTaipei Medical University TaipeiTaipeiTaiwan

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