Risk factors associated with venous thromboembolism in rheumatoid arthritis in clinical practice.

Objectives: To identify classical or disease-related risk factors of venous thromboembolic events (VTE) in rheumatoid arthritis (RA) patients in clinical practice.

Methods: Cross-sectional single-centre study conducted on consecutive RA patients over a 24-month period. Electronic medical reports were used to identify the occurrence of VTE after 2018 (JAK inhibitors, JAKi, availability in France) and to collect RA disease characteristics/VTE risk factors. Multivariate logistic regression analysis was performed to identify factors independently associated with VTE.

Results: Among 469 RA patients (81% women, mean age 59±14 years), 15 had VTE (3%) after 2018, with a mean interval of 4.5±5.6 months between the occurrence of VTE and the clinical evaluation. The strongest risk factor of VTE was the history of previous VTE with an OR of 44.74 (95% CI 8.83-226.68). We identified hospitalisation up to 3 months before the occurrence of VTE and also diabetes as other factors independently associated with the occurrence VTE, with respective OR of 6.82 (95% CI 1.60-29.11) and 11.23 (95% CI 2.21-57.01). Among RA therapies, JAKi were significantly associated with the occurrence of VTE (OR 5.54, 95% CI 1.03-29.72).

Conclusions: In this study of RA patients, history of VTE and recent hospitalisation were identified as strong risk factors of VTE. Moreover, it emphasises the importance of evaluating cardiovascular risk factors, particularly diabetes, for both arterial and venous thromboembolism risks. Finally, JAKi should be used with caution in patients with risk factors for VTE, as recommended by the Pharmacovigilance Risk Assessment Committee and the French Society of Rheumatology.