Rheumatoid arthritis and stroke risk: a systematic review and meta-analysis

This meta-analysis aims to evaluate the association between rheumatoid arthritis (RA) and stroke risk. Methods: PubMed, Cochrane Library, and Embase were searched for observational studies published from database inception to October 7, 2025, using medical subject headings (MeSH) and keywords. Random effect models were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for evaluating the associations between RA and stroke risk. All statistical analyses were performed using Stata statistical software version 17.0. The funnel plot, Egger's test and Begg's test were used to evaluate publication bias.

This meta-analysis included 12 observational studies with a total of 1,715,001 participants, published between 2003 and 2025. The pooled analysis revealed a significant association between RA and increased stroke risk (OR = 1.35; 95% CI [1.26-1.45]; P = 0.000). Subgroup analysis showed that women with RA had a slightly higher stroke risk than men (OR = 1.60; 95% CI [1.19-2.16]; P = 0.002). Additionally, RA patients aged over 65 were at higher risk of stroke (OR = 1.24; 95% CI [1.02-1.50]; P = 0.032). No significant publication bias was detected, and sensitivity analyses confirmed the robustness of our findings.

This meta-analysis demonstrates that RA is associated with an increased risk of stroke, supporting the recognition of RA as an independent stroke risk factor.