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Derangement of hemostasis in rheumatoid arthritis: association with demographic, inflammatory and metabolic factors

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Abstract

Disturbance of fibrinolysis is common in rheumatoid arthritis (RA), and it may be associated with the increased cardiovascular risk observed in this population. We aimed to assess coagulation derangement and investigate whether abnormalities are influenced by demographic, inflammatory or metabolic factors in patients with RA. Levels of tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI-1), fibrinogen, prothrombin fragment 1 + 2 (PF1 + 2), thrombomodulin (TM), protein C and Von Willebrand factor (vWF) were compared between 141 RA patients and 50 healthy hospital controls. Within RA, coagulation factors were assessed alongside several demographic, inflammation and metabolic indicators. RA patients had higher levels of coagulation factors than controls. After correction for age and sex, having RA predicted increased tPA (B = 0.15, P < 0.001), PAI-1 (B = 0.21, P < 0.001), fibrinogen (B = 0.86, P < 0.001), PF1 + 2 (B = 0.20, P < 0.001), and TM (B = 0.01, P = 0.03) levels. CRP correlated positively with tPA (P < 0.05), fibrinogen (P < 0.001), TM (P < 0.05), PF1 + 2 (P < 0.001) and vWF (P < 0.001). Metabolic factors linked with coagulation factors were hypertriglyceridaemia (tPA, P < 0.05; PAI-1, P < 0.05; protein C, P < 0.05) and insulin resistance (tPA, P < 0.01; PAI-1, P < 0.01; vWF, P < 0.05). Imbalance of coagulation and fibrinolytic mechanisms is common in RA and associates with age, inflammation, and metabolic factors. Further studies may determine whether these abnormalities are the consequence of acute inflammation or markers of vascular dysfunction.

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Acknowledgments

Dr Theodoros Dimitroulas has been supported by the Rheumatology Society of Northern Greece and the Hellenic Society for Rheumatology.

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Authors and Affiliations

  1. Department of Rheumatology, Dudley Group of Hospitals, NHS FT, Dudley, West Midlands, DY1 2HQ, UK

    Theodoros Dimitroulas, Karen M. J. Douglas, Vasileios F. Panoulas, Tracey Toms, Jacqueline P. Smith & George D Kitas

  2. Department of Psychology, University of Otago, Dunedin, New Zealand

    Gareth J. Treharne

  3. Wolfson Computer Labaratory, University Hospitals of Birmingham, Birmingham, NHS FT, UK

    Peter Nightingale & James Hodson

  4. Arthritis Research UK Epidemiology Unit, School of Translational Medicine, University of Manchester Rutherford House, Manchester Science Park 40 Pencroft Way, Manchester, M15 6SZ, UK

    George D Kitas

  5. Department of Rheumatology, Russells Hall Hospital, Dudley Group of Hospitals, DY1 2HQ, Dudley, West Midlands, UK

    Theodoros Dimitroulas

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  1. Theodoros Dimitroulas
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  2. Karen M. J. Douglas
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  3. Vasileios F. Panoulas
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Correspondence to Theodoros Dimitroulas.

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Theodoros Dimitroulas and Karen M. J. Douglas are joint first authorship.

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Dimitroulas, T., Douglas, K.M.J., Panoulas, V.F. et al. Derangement of hemostasis in rheumatoid arthritis: association with demographic, inflammatory and metabolic factors. Clin Rheumatol 32, 1357–1364 (2013). https://doi.org/10.1007/s10067-013-2283-6

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