Korean J Geriatr Gerontol.  2022 Dec;23(2):96-114. 10.15656/kjcg.2022.23.2.96.

Acute Ischemic Stroke in the Patients with Inflammatory Arthritis: An Analysis of Data from National Health Insurance Service

• Lee K
• Choi JK
• Park Js
• Pyo JY
• Han M
• Lee JH

• KMID: 2566379
• DOI: http://doi.org/10.15656/kjcg.2022.23.2.96

Abstract

Background
Inflammation is an important mechanism in stroke. To a considerable extent, the pathophysiology of inflammatory arthritis is influenced by inflammatory cells and cytokines. We compared the risk of stroke between patients with inflammatory arthritis and matched controls, using data from the National Health Insurance Service.
Methods
Using a combination of primary diagnosis and V codes for rare incurable diseases, we defined the patients with ankylosing spondylitis, seropositive rheumatoid arthritis, and psoriatic arthritis and enteropathic spondyloarthropathy. The control group was defined by 1:5 propensity score-matching for each disease. Newly developed stroke was identified in the patients with the primary diagnosis of (I60-64) and 1) brain imaging or 2) a prescription of stroke medication or related intervention.
Results
The occurrence of stroke was more frequently associated with seropositive rheumatoid arthritis in both the patient population and the seropositive rheumatoid arthritis control group (hazard ratio 1:11, 95% CI 1.02-1.20, P=0.012). In this study, the frequency of stroke occurrence was not associated with the diagnosis of ankylosing spondylitis nor psoriatic arthritis or enteropathic spondyloarthropathy. Furthermore, the use of biologic agents was not associated with the occurrence of stroke, using multivariable analyses in the three different types of inflammatory arthritis and their respective control groups.
Conclusion
Seropositive rheumatoid arthritis was a predictor of frequent stroke occurrences. The patients with seropositive rheumatoid arthritis must be cautious with regard to the occurrence of a comorbid stroke. Further studies with long-term follow-ups of clinical outcomes are warranted to explain the underlying correlation between inflammatory arthritis and the risk of stroke.

Keyword

Ankylosing spondylitis; Inflammatory arthritis; Psoriatic arthritis; Rheumatoid arthritis; Stroke