METHODS: The South Korean Health Insurance Review and Assessment Service database was used to identify patients newly diagnosed with SPRA between 2010 and 2020. A nested case-control analysis was performed to match AF-affected patients to unaffected controls for age, sex, follow-up duration, and index year of SPRA diagnosis at a 1:4 ratio. Adjusted conditional logistic regression was used to identify the predictive factors for AF.
RESULTS: Of the 108 085 patients with SPRA, 2,629 (2.4%) developed new-onset AF, and the proportion of females was ∼67%. In the matched population, pre-existing comorbidities of hypertension, chronic kidney disease, and heart failure were associated with increased risk of AF. Meanwhile, the use of methotrexate (MTX) decreased the risk of incident AF [adjusted odds ratio (aOR), 0.89], whereas the use of leflunomide (LEF) increased AF (aOR, 1.21). In a subgroup of patients aged ≥50 years, LEF and adalimumab increased the occurrence of AF, while MTX decreased AF in males and LEF increased this risk in females.
CONCLUSIONS: Although the number of subjects developing new-onset AF was small, MTX decreased and LEF increased incident AF in patients with RA. Especially, a distinct pattern of AF risk with DMARDs usage was observed according to age and sex.
方法:使用韩国健康保险审查和评估服务数据库来识别2010年至2020年间新诊断为SPRA的患者。进行巢式病例对照分析,以将受房颤影响的患者与未受影响的对照组进行年龄匹配。性别,随访持续时间,SPRA诊断的指标年为1:4。使用调整后的条件逻辑回归来确定AF的预测因素。
结果:在108085例SPRA患者中,2,629(2.4%)出现新发房颤,女性比例为67%。在匹配的人群中,预先存在的高血压合并症,慢性肾病,心力衰竭与房颤风险增加相关。同时,甲氨蝶呤(MTX)的使用降低了房颤事件的风险[校正比值比(aOR),0.89],而使用来氟米特(LEF)增加了AF(aOR,1.21).在年龄≥50岁的患者亚组中,LEF和阿达木单抗增加了房颤的发生率,而MTX降低了男性的房颤,而LEF增加了女性的这种风险。
结论:尽管发生新发房颤的受试者数量很少,RA患者的MTX降低,LEF增加了房颤事件。尤其是,根据年龄和性别,观察到使用DMARDs的房颤风险的不同模式.