Increased Incidence of Stroke and Transient Ischemic Attack in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis in Germany

Neuroepidemiology. 2021;55(2):162-170. doi: 10.1159/000514889. Epub 2021 Mar 31.


Background: As chronic inflammatory diseases may be associated with an increased risk of vascular events, the aim of the present study was to assess the incidence of stroke and transient ischemic attack (TIA) in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS).

Methods: Patients diagnosed with RA and AS in 1,262 general practices in Germany between 2000 and 2015 were selected. RA and AS patients were matched to patients without RA or AS using propensity scores based on age, sex, physician, co-diagnoses, and co-therapies. The Kaplan-Meier curves and Cox regression models were used to study the incidence of stroke and TIA as a function of RA and AS.

Results: In the study population (N = 29,106; mean age 54.8 years; 65% women), 24,580 patients had RA and 4,526 had AS. RA was significantly associated with the stroke (hazard ratio [HR] = 1.42, confidence interval [CI]: 1.25-1.60) and TIA (HR = 1.69, CI: 1.46-1.95). The association between RA and stroke was strongest in the age group 18-40 years (HR = 3.45, CI: 1.30-9.18). The HR for stroke in AS was 1.41 (CI: 0.99-2.00) and for TIA 1.62 (1.08-2.44).

Conclusion: RA was significantly associated with stroke and TIA, with young patients being at a particularly increased risk. AS was tendentially associated with stroke and TIA.

Keywords: Ankylosing spondylitis; Cohort studies; Rheumatoid arthritis; Stroke; Transient ischemic attack.