SAN ANTONIO — Prednisone treatment for rheumatoid arthritis patients was associated with an approximately 50% increased risk of stroke, according to figures from the National Data Bank for Rheumatic Diseases.
Treatment with infliximab was associated with a 50% decreased stroke risk. These findings don't in any way prove cause and effect, the study's lead investigator, Frederick Wolfe, M.D., cautioned in an interview. But they are suggestive of a trend.
They may also challenge some assumptions among providers. “There is a belief that low-dose prednisone is a benign drug treatment,” said Dr. Wolfe of the National Data Bank. “I don't think it is.”
Dr. Wolfe, who presented his findings in a poster presentation at the annual meeting of the American College of Rheumatology, said that his look at the incidence rate of stroke in rheumatoid arthritis (RA) patients was prompted by a request from investigators at the National Institutes of Health, who wanted to know about stroke risk and infliximab treatment. The study used data from 15,670 RA patients and 3,083 osteoarthritis patients, who were followed for a 3-year period ending in 2003.
RA patients had a higher incidence of stroke than did the osteoarthritis patients, with a hazard ratio of 1.26. This increased risk was independent of age, gender, diabetes, and hypertension. The incidence rate in the RA patients was equal to 8 cases per 1,000 patient-years.
Among the RA patients, stroke risk was increased in those on prednisone, with a hazard ratio of 1.52, and decreased in those on infliximab, with a hazard ratio of 0.49. Concurrent methotrexate therapy did not appear to have an impact on risk of stroke.
Sulfasalazine treatment was also found to be associated with a 50% decreased risk; however, there were too few patients in the group who took sulfasalazine for that finding to be considered statistically significant, Dr. Wolfe noted.