Risk of ischemic stroke associated with anti-rheumatic agents in patients with rheumatoid arthritis: A nationwide population-based case-control study

PMCID: PMC12173416

PMID: 40526615

DOI: 10.1371/journal.pone.0326311

Journal: PloS one

Publication Date: 2025-6-17

Authors: Ahn SM, Kim S, Kim YJ, Hong S, Lee CK, et al.

Key Points

• Sulfasalazine and hydroxychloroquine were associated with reduced stroke risk in RA patients
• Glucocorticoids showed a 71% increased stroke risk (aOR: 1.71, 95% CI: 1.46–2.00)
• Clinicians should consider cardiovascular risk when selecting anti-rheumatic medications for RA patients

Summary

This nationwide nested case-control study investigated the association between anti-rheumatic agents and stroke risk in 35,133 patients with rheumatoid arthritis (RA) using Korean health insurance claims data. Among the cohort, 1,386 patients (3.9%) developed new-onset stroke during a median follow-up of 9.92 years, providing a comprehensive analysis of medication-related stroke risk in RA patients.

The study revealed significant variations in stroke risk across different anti-rheumatic medications. Sulfasalazine and hydroxychloroquine were associated with a decreased stroke risk (adjusted odds ratios of 0.79 and 0.83, respectively), while glucocorticoids and tocilizumab demonstrated increased stroke risk (adjusted odds ratios of 1.71 and 3.47, respectively). These findings highlight the complex cardiovascular implications of RA treatment and underscore the importance of carefully selecting medications with consideration of individual patient cardiovascular risk profiles.