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Chronic inflammation induced by rheumatoid arthritis (RA) leads to endothelial injury and hypercoagulability and contributes to venous thromboembolism (VTE).
Patients with RA are associated with double the risk of VTE when compared with age- and sex-matched controls.
The incidence of VTE is highest during the first year after RA diagnosis or after hospitalization.
Biological disease-modifying anti-rheumatic drugs may be associated with an increased risk of VTE.
Criteria for extending anticoagulation in patients with RA after an acute episode of VTE are unknown and need to be determined in the future.
Rheumatoid arthritis (RA) is a chronic autoimmune joint disease with persistent systemic inflammation. Patients with RA suffer from joint pain and physical disability, but have their prognosis mostly driven by cardiovascular events, including venous thromboembolism (VTE). The risk of VTE is more than double in patients with RA compared with the general population. The incidence rate in patients with RA is estimated around 4 cases per 1000 person-years. The etiology of thrombotic tendency in RA is linked to various mechanisms and causal factors (antiphsolpholid antibodies, hyperhomocyteinemia, inflammation…): vascular injury, hypercoagulation, and venous stasis, the three components of the Virchow's triad, are activated in patients with RA. In clinical practice, situations that put patients for VTE should be identified (e.g., surgery, first year after RA diagnosis, hospitalization for acute illness…). Patients with RA are exposed to reversible risk factors, such as major surgery (knee or hip surgery) or hospitalization with immobilization. Similarly, uncontrolled RA, which is defined by the necessity to switch a biological disease-modifying anti-rheumatic drugs (DMARD), increases the incidence of VTE in observational studies. Moreover, DMARDs may impact the risk of VTE, especially in the time window after first prescription. Several biological DMARDs like tofacitinib have been associated with an increased risk of VTE. Therefore, patients with RA may require specific measures in terms of VTE diagnosis and management. In this review, we provide current insights into the pathophysiology, epidemiology, clinical considerations, and treatment strategies of VTE highlighting gaps in evidence and perspectives in patients with RA.Le texte complet de cet article est disponible en PDF.
Keywords : Venous thromboembolism, Deep venous thrombosis, Pulmonary embolism, Inflammation, Rheumatoid arthritis, Disease-modifying anti-rheumatic drugs
Vol 88 - N° 3Article 105122- mai 2021 Retour au numéro
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