Whole-blood coagulation and platelet dynamics identify differential prothrombotic states in patients with rheumatoid arthritis treated with JAK or TNF-ɑ inhibitors
Authors' conclusion
RA is characterised by enhanced clot firmness and platelet reactivity. JAKi therapy was independently associated with higher viscoelastic clot strength compared with TNFi, while inflammatory burden and glucocorticoid exposure were key determinants of prothrombotic signatures.
Study context
- Population
- Patients with rheumatoid arthritis (RA) on stable Janus kinase inhibitors (JAKi) or tumour necrosis factor inhibitors (TNFi) therapy (>3 months) and healthy controls, single centre61 RA and 34 healthy controls (HC)
- Participants
- 30 / 31 / 34
- Exposure
- RA treated with JAKi vs TNFi, and vs healthy controls
- JAKin = 30
- TNFin = 31reference
- HCn = 34
- Outcome
- Co-primary: whole-blood thrombogenic potential (rotational thromboelastometry (ROTEM)) and platelet reactivity (MULTIPLATE impedance aggregometry)
Methodological detailssingle-centre, observational, multivariable linear regression
- Single-centre
- Observational
- Multivariable linear regression
Main finding
As reported in the abstract
Maximum clot firmness (MCF), RA vs HC, and JAKi vs TNFi (multivariable)
Β (EXTEM maximum clot firmness (MCF))
2.32
95% CI 0.42–4.23P = 0.018
JAKi
Β (FIBTEM MCF)
1.72
95% CI 0.07–3.37P = 0.041
JAKi
- RA vs HC: INTEM MCF 63.4±4.0 vs 57.2±4.1 mm
- all p<0.001
- RA vs HC: EXTEM MCF 66.2±4.1 vs 55.9±4.7 mm
- all p<0.001
- RA vs HC: FIBTEM MCF 15.7±3.6 vs 12.4±3.7 mm
- all p<0.001
- RA vs HC: enhanced platelet aggregation
- all p<0.001
Observational data: associations, not effects.
Further findings
Predictors: prednisone dose predicted INTEM and EXTEM MCF; SDAI predicted ADP-induced aggregation
- SDAI and ADP-induced aggregation, β
- 11.34 (95% CI 4.31 to 18.37; p=0.002)
- Prednisone dose independently predicted INTEM and EXTEM MCF
Original publication
Whole-blood coagulation and platelet dynamics identify differential prothrombotic states in patients with rheumatoid arthritis treated with JAK or TNF-ɑ inhibitors. RMD Open. Published 10 August 2026. doi:10.
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