The risk of stroke in rheumatoid arthritis patients: a Meta-analysis / 中华风湿病学杂志

ABSTRACT

Objective To study whether rheumatoid arthritis (RA) increased the risk of stroke by systematically reviewing the literature. Methods Databases including PubMed, Web of Science, CNKI, Wan Fang database, The Cochrane Library (Issue 12, 2017), Embase and Sinomed database were searched to collect case-control studies and cohort studies up to February 1, 2018. The association between RA and stroke was analyzed. Meta-analysis and sub-group meta-analysis were conducted using Revman 5.3 software, and sensitive analysis and publication bias analysis were performed using Stata12.0 software. Results Finally 19 studies involving 248784 RA patients and 5970133 controls were included. Heterogeneity test was carried out and heterogeneity of each study was found to be statistically significant ( χ2=442.77, P<0.01, I2=96％), thus, the random effect model was used for meta-analysis. The risk of RA patients with stroke was 1.40 (1.21, 1.61) compared to the general population or patients without RA. Further subgroup analysis was performed by stratifing for race than indicating that the risk of RA combined with stroke was 1.21 (1.03, 1.56) versus one of non-RA patients among Caucasian. When stratified by whether control group matched on age and sex, the data had shown that the risk of RA with stroke was higher than that of the non-RA patients, whether control group was matched or not, and the risk ratio was 1.36(1.16, 1.60), 1.47(1.00, 2.15) respectively (P=0.001, P=0.05). When stratified by whether arthrophlogosis and/or immune related diseases were excluded in the control group, the risk of RA patients with stroke was 1.45(1.23, 1.72) compared to the non-RA patients when related diseases were not excluded (P<0.01). Conclusion RA patients may have a higher risk of stroke than the general population or patients without RA, especially in Caucasians.