Rheumatoid arthritis and malignant lymphomas

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Curr Opin Rheumatol. 2004 May;16(3):254-61.

Rheumatoid arthritis and malignant lymphomas.

Baecklund E, Askling J, Rosenquist R, Ekbom A, Klareskog L.

Department of Rheumatology, Uppsala University Hospital, SE-751 85

Uppsala, Sweden. Eva.Baecklund@...

PURPOSE OF REVIEW: The reason for the increased lymphoma risk in

patients with rheumatoid arthritis (RA) has remained unclear. Reports of

lymphomas in patients treated with TNF-blockers have brought renewed

interest in this issue. This review summarizes data on possible associations

between RA and lymphomas, including different treatments and RA disease

related risk factors. RECENT FINDINGS: Some recent studies reported

increased lymphoma risks linked to RA disease activity. The hypothesis that

disease-modifying drugs, and in particular methotrexate, would increase the

lymphoma risk receives little support. Observation times for the

TNF-blocking therapies are still short, but so far no clear increased risk

for lymphoma has been observed. Presence of Epstein-Barr virus, as analyzed

with EBER in situ hybridization, appears to be uncommon in RA related

lymphomas. Hypothetically, an increased proliferative drive caused by self

or non-self antigens may play a role in lymphoma development in RA patients,

but this has to be further studied. SUMMARY: Rheumatologists need to be

aware of the increased lymphoma risk in their RA patients. The reason for

the increased lymphoma risk in RA patients is still unclear, but available

studies rather support the hypothesis of a link between RA disease severity

and the risk of lymphoma than increased risks associated with specific

treatment regimens. To facilitate the future evaluation of lymphoma risks in

connection with treatment, we suggest that patients treated with new drugs

should be subject to structured surveillance. Collected information should

include data about RA disease activity and severity.

PMID: 15103253 [PubMed