MTX and RA and lymphoma

[Guest guest]

" There are an increasing number of reports of lymphoma in patients

treated with methotrexate for rheumatoid arthritis.6-8 Extranodal

involvement is common, occurring in 69% of cases, although, in contrast

to findings in AIDS patients and patients having transplantation, high

frequencies of brain involvement have not been found.6 The predominant

lymphoma type is large B-cell, non-Hodgkin's lymphoma. Epstein-Barr

virus has been found in the lymphoma cells in 41% of cases.6

The strongest causal link is spontaneous lymphoma remission after

stopping methotrexate. This has been documented in at least 15 patients

with rheumatoid arthritis,6-8 with remission occurring within 4 weeks of

stopping the drug. Therefore, a period of observation without

immunosuppressive treatment is mandatory.

Given the widespread use of methotrexate in rheumatoid arthritis, the

number of reported cases is small. The increased risk of lymphoma in

rheumatoid arthritis patients treated with methotrexate is probably

real, but it is a low risk. It has been suggested that this effect of

methotrexate and of cyclosporin occurs only in the subgroup of

rheumatoid arthritis patients who already have severely disturbed

immunity.7,9,10 Immunosuppressive treatment may lead to even poorer

oncogenic surveillance and the survival of a malignant clone. As

combination therapy, such as methotrexate and cyclosporin, becomes more

widespread, physicians will have to be more aware of the potential for

lymphoma. "

eMJA

MJA 2002 177 (9): 500-501

" Remission of lymphoma after drug withdrawal in rheumatoid arthritis " :

http://www.mja.com.au/public/issues/177_09_041102/lim10170_fm.html

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org