Background Venous thromboembolic events (VTE) such as deep vein thrombosis, thrombophlebitis and thromboembolism of pulmonary artery are an important clinical problem that concerns all spheres of medicine. Patients with chronic inflammatory diseases including RA have an increased risk of venous thromboembolism. It is important to determine risk factors of VTE in patients with RA (standard and associated with disease) for prevention of thrombosis.
Objectives To determine prognostic risk factors of venous thromboembolic events in patients with rheumathoid arthritis.
Methods 362 patients (F:302, M:61) with definite diagnosis of rheumathoid arthritis were analyzed, 53,7 ± 13,3 years old, duration of disease 12,4 ± 10,9 years. All patients were hospitalized in V.A. Nasonova Reasearch Institute of Rheumatology. Doppler ultrasound of lower limbs veins were done to patients with suspected thrombosis or with thrombosis in past history. Patients were divided in 2 groups: 1st Gr included patients with thrombosis in a moment or in past history – 34/362 (9,9%) and 2nd Gr - patients and without thrombosis – 328/362 (90,1%). Analysis of risk factors was done according to questionnaire survey and medical history. Disease activity was expressed as DAS28 score which is a composite score derived from tender joint count, swollen joint count, ESR and patient's global assessment of disease activity. Possible prognostic risk factors included age (>40 years, >60years, >75 years), body mass index (BMI) >30, smoking, pregnancy and childbirth, taking antifertility agents, immobilization, surgical treatment, traumas, fractures, diabetes mellitus, pulmonary diseases, cardiac failure, varicose vein disease, cancer, oral and intra-articular (<5 and >5 injections) introduction of glucocorticoids (GCs). In order to identify predictors of venous thromboembolic events we used multivariance analysis (discriminant function classification).
Results Multivariance analysis showed that the thrombosis is mainly influenced by following factors: immobilization, cardiac failure, varicose vein disease, oral and intra-articular (>5 injections) introduction of GCs; weighted coefficients: 1,0; 0,92; 3,13; 0,02; 0,52. Function of prediction of thrombosis is suggested:
Z =1,0 * immobilization (Yes-1/No-0) + 0,92* cardiac failure (Yes-1/No-0) + 3,13* varicose vein disease (Yes-1/No-0) + 0,02* oral GCs (yes-1/No-0) + 0,52* intra-articular (>5 injections) introduction of GCs (Yes-1/No-0).
The value of function Z=1,65 divides patients with and without venous thromboembolic events, sensitivity 64%, specificity 82%, positive predictive relevance 80%.
Conclusions Adverse prognostic factors of venous thromboembolic events in patients with rheumathoid arthritis are immobilization, cardiac failure, varicose vein disease, oral and intra-articular (>5 injections) introduction of GCs.
Disclosure of Interest None declared
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