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<p>Systemic inflammation and hypercoagulability are two major characteristics of rheumatoid arthritis (RA), both contributing to atherosclerosis development. This study aims to evaluate their joint and mutual associations with early atherosclerosis risk in RA patients via the systemic inflammation response index (SIRI) and thromboelastography maximum amplitude (TEG-MA). The study encompassed 335 RA patients who fulfilled the specified inclusion criteria. Logistic regression assessed SIRI, TEG-MA, and their combined link to early atherosclerosis risk. Both multiplicative and additive interactions were evaluated, and a bidirectional mediation model explored their reciprocal impacts on early atherosclerosis. After full confounder adjustment, SIRI and TEG-MA both showed significant positive links to early atherosclerosis risk, whether analyzed as continuous or categorical variables (<i>P</i> &lt; 0.05). In joint analyses, RA patients with both high SIRI and TEG-MA had a 10.06-fold higher risk than those with low levels of both (odds ratio [OR]: 10.06, 95% confidence interval [CI]: 3.75–25.90). SIRI and TEG-MA showed notable additive interaction in affecting atherosclerosis risk, with relative excess risk of interaction (RERI) at 4.03 (95% CI: 1.25–9.36), attributable proportion of interaction (API) at 0.42 (95% CI: 0.03–0.79), and synergy index (SI) at 1.73 (95% CI: 1.03–2.96). No significant multiplicative interaction was detected (<i>P</i> &gt; 0.05). Mutual mediation analysis showed SIRI mediated 40.6% of TEG-MA’s effect, while TEG-MA mediated 27.6% of SIRI’s effect on atherosclerosis risk. These results suggest that there is an intertwined and mutually reinforcing relationship between inflammation and hypercoagulability in the occurrence and progression of atherosclerosis in RA.</p>

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Joint association of systemic inflammatory response index and thromboelastography maximum amplitude with the risk of early atherosclerosis in patients with rheumatoid arthritis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月8日

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  • Qinglin Zhang,
  • Qian Xu,
  • Rong Huang,
  • Rui Yin,
  • Mingzhong Sun,
  • Dongmei Jiang,
  • Hui Tao,
  • Hao Jin

摘要

Systemic inflammation and hypercoagulability are two major characteristics of rheumatoid arthritis (RA), both contributing to atherosclerosis development. This study aims to evaluate their joint and mutual associations with early atherosclerosis risk in RA patients via the systemic inflammation response index (SIRI) and thromboelastography maximum amplitude (TEG-MA). The study encompassed 335 RA patients who fulfilled the specified inclusion criteria. Logistic regression assessed SIRI, TEG-MA, and their combined link to early atherosclerosis risk. Both multiplicative and additive interactions were evaluated, and a bidirectional mediation model explored their reciprocal impacts on early atherosclerosis. After full confounder adjustment, SIRI and TEG-MA both showed significant positive links to early atherosclerosis risk, whether analyzed as continuous or categorical variables (P < 0.05). In joint analyses, RA patients with both high SIRI and TEG-MA had a 10.06-fold higher risk than those with low levels of both (odds ratio [OR]: 10.06, 95% confidence interval [CI]: 3.75–25.90). SIRI and TEG-MA showed notable additive interaction in affecting atherosclerosis risk, with relative excess risk of interaction (RERI) at 4.03 (95% CI: 1.25–9.36), attributable proportion of interaction (API) at 0.42 (95% CI: 0.03–0.79), and synergy index (SI) at 1.73 (95% CI: 1.03–2.96). No significant multiplicative interaction was detected (P > 0.05). Mutual mediation analysis showed SIRI mediated 40.6% of TEG-MA’s effect, while TEG-MA mediated 27.6% of SIRI’s effect on atherosclerosis risk. These results suggest that there is an intertwined and mutually reinforcing relationship between inflammation and hypercoagulability in the occurrence and progression of atherosclerosis in RA.