RA and malignant lymphomas

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Curr Opin Rheumatol. 2004 May;16(3):254-261.

Rheumatoid arthritis and malignant lymphomas.

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

Department of Rheumatology, Uppsala University Hospital, Uppsala;

Rheumatology Unit, Department of Medicine, Karolinska Institutet,

Karolinska Hospital, Stockholm; Clinical Epidemiology Unit, Karolinska

Institutet/Karolinska Hospital, Stockholm; Department of Genetics and

Pathology, Uppsala University, Uppsala, Sweden.

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

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