Given the recent concerns regarding venous thromboembolic events in patients with rheumatic disease and pre-existing cardiovascular risk factors being treated with tofacitinib, investigators addressed the occurrence of VTE in patients with PsA.
In patients with psoriatic arthritis (PsA), an increase in the risk of venous thromboembolic (VTE) events was associated with underlying comorbidities, rather than the condition itself, according to a study published in Arthritis Research and Therapy.1 VTE in patients with PsA was linked with older age and a previous history of VTE.
“Very few studies have addressed the occurrence of VTE events among psoriasis (PsO) patients, and even fewer in PsA,” investigators stated. “This is of particular significance given the recent concern raised over increased incidence of VTE events among patients with rheumatoid arthritis (RA), PsO, and PsA with pre-existing cardiovascular risk factors treated with tofacitinib.”
This retrospective cohort study examined newly diagnosed patients with PsA between January 2003 and December 2018 using data from the largest health care provider in Israel, Clalit Health Services (CHS). Patients were then matched for age, sex, ethnicity, and index data with up to 4 controls within the same database. Occurrence of VTE was noted across all groups through June 30, 2019. Information about demographics, smoking status, and socioeconomic status, body mass index (BMI), comorbidities, and medication was obtained. Cox proportional hazard regression determined any association between VTE and PsA.
The primary endpoint was defined as the diagnosis of VTE, including deep venous thrombosis (ICD-9, 453.4X, 451.1X) and pulmonary embolism (ICD-9, 415.1X).
A total of 5,275 patients with PsA were matched with 21,011 controls. Patients with PsA had a mean age of 51.7 years and 53.2% were female. The PsA group were more likely to be diagnosed with diabetes (33.8% vs 26.2%, p<0.0001, SMD=0.2) and obesity (BMI≥30 in 33.5% vs 25.8%, p<0.0001, SMD=0.2) when compared with controls.
While 1.2% (n = 62) of patients in the PsA group were diagnosed with VTE compared with 0.8% (n = 176) in the control group, there was no increased risk of VTE among patients with PsA based on multivariable analysis (p=0.16, HR=1.27, 95% CI 0.91-1.80). The analysis adjusted for demographics, socioeconomic factors, comorbidities, smoking, obesity, and cardiovascular risk factors.
Patients who developed VTE tended to be older, with a mean age of 64.9±13.2 years, when compared with those without VTE (51.5±15.4 years). These patients were also more likely to have a history of VTE (14.9% vs 0.8%, p<0.0001, respectively). Older age [p<0.0001, HR 1.08, CI (1.06-1.10)] and previous history of VTE [p<0.0001, HR 31.63, CI (14.20-70.60)] were the only factors associated for increased risk in the PsA group.
A limitation of the study was the small number of VTE events in patients with PsA in the CHS database, which hindered determination of association in the multivariable analysis. Further, database limitations included the possibility of unknown confounders and misclassification, as well as a lack of PsA disease activity information. However, the study design, utilizing a large database of long-term follow-up data on 4.7 million people, including patients with PsA, strengthened the findings.
“Given the association of VTE with comorbidities common in PsA patients, our findings do support continued research into VTE risk factors in PsA and active surveillance of this patient population for VTE occurrence especially in an era of medications such as JAK inhibitors,” investigators concluded.
Gazitt T, Pesachov J, Lavi I, et al. The association between psoriatic arthritis and venous thromboembolism: a population-based cohort study. Arthritis Res Ther. 2022;24(1):16. Published 2022 Jan 7. doi:10.1186/s13075-021-02703-8