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22 décembre 2011 4 22 /12 /décembre /2011 22:29
MedWire News : People admitted to hospital with an autoimmune disorder have a high risk for pulmonary embolism (PE) in the year after admission, Swedish study data show.

This risk decreases over time, but remains elevated for at least 10 years, report Bengt Zöller (University Hospital, Malmö) and colleagues in The Lancet .

The researchers explain that some autoimmune disorders have been linked to venous thromboembolism (VTE), but previous studies have often been small and focused on one particular condition.

Zöller and team therefore examined records from a Swedish national database to investigate whether there is an association between all autoimmune disorders and the risk for PE.
They included all individuals admitted to hospital in Sweden with a primary or secondary diagnosis of an autoimmune disorder between 1964 and 2008.

Standardized incidence ratios (SIRs) for PE among the patients with autoimmune disorders were calculated using the total population of Sweden as the reference population.

A total of 535,538 individuals were admitted to hospital because of an autoimmune disorder, most commonly rheumatoid arthritis (16%), Hashimoto's thyroitis (11%), and Graves' disease (10%). Of these patients, 15,607 without a history of previous VTE were subsequently admitted for PE.

Overall, patients with the 33 most common autoimmune disorders were 6.38 times more likely to develop PE than people in the general population. The risk was particularly high among patients with chorea minor (SIR=16.67), polymyositis and dermatomyositis (SIR=16.44), polyarteritis nodosa (SIR=13.26), and discoid lupus erythematosus (SIR=12.00).

The researchers note that the overall risk for PE decreased over time, from a SIR of 1.53 during years 1-5, to 1.15 during years 5-10, and 1.05 after 10 years or more years.

This suggests that "the thrombotic risk is linked to the inflammatory activity of the autoimmune disorders, which is likely to decrease over time because of treatment," they write.

However, after more than 10 years of follow-up, the risk for PE remained significantly higher than that expected in the general population among patients initially admitted with polymyalgia rheumatica (SIR=1.17), rheumatoid arthritis (SIR=1.12), and ulcerative colitis (SIR=1.29).

Zöller and team conclude: "Autoimmune disorders in general should be regarded not only as inflammatory disorders, but also as hypercoagulable disorders.

"Prophylaxis could be warranted in patients admitted with autoimmune disorders or at least for those disorders for which the risk of pulmonary embolism was very high," they suggest.

By Laura Dean

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