Rheumatoid Arthritis Drugs Won't Boost Lymphoma Risk

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Rheumatoid Arthritis Drugs Won't Boost Lymphoma Risk

02.27.06, 12:00 AM ET

MONDAY, Feb. 27 (HealthDay News) -- Experts have long known that

rheumatoid arthritis boosts the risk for lymphoma, but the reason for

this connection has remained unclear.

Now, Swedish research suggests it isn't due to the treatments for the

disease, as some had feared.

Instead, chronic inflammation linked to illness appears to be the

culprit, with cancer risk rising as the arthritis worsens. According

to experts, this means that drugs that keep rheumatoid inflammation

to a minimum may be crucial in curbing both the arthritis and its

associated lymphoma risk.

" What this study is showing is, not only is there not a cause-effect

relationship with treatment [and lymphomas], but the cause and effect

is really with the severity of the disease, " said Dr. ,

national medical advisor for the Arthritis Foundation and chief of

rheumatology at Piedmont Hospital in Atlanta.

He was not involved in the study, which appears in the March issue of

Arthritis & Rheumatism.

Rheumatoid arthritis is a chronic disease, marked by inflammation of

the lining of the joints. Over time, the disease can cause long-term

joint damage, chronic pain, immobility and disability. About 2

million Americans have rheumatoid arthritis, according to the

Arthritis Foundation. A variety of medications are used to treat the

disease, including nonsteroidal anti-inflammatory drugs (NSAIDs),

other analgesic drugs, prednisone, disease-modifying anti-rheumatic

drugs and newer " biologic-response modifiers, " which directly modify

the immune system.

" The major concern and the common interpretation of earlier reports

and studies have been that the drugs used to treat rheumatoid

arthritis also leads to increased lymphoma risk, " explained study co-

author Dr. Eva Baecklund, of University Hospital in Uppsala.

However, " reading the existing medical literature critically, I would

say that results have been conflicting, " Baecklund said, adding that

no specific drug has ever been linked to increased lymphoma risk.

In their study, Baecklund's team evaluated the records of nearly

75,000 rheumatoid arthritis patients, zeroing in on 378 patients who

also developed lymphoma. They then compared those patients to 378

healthy controls.

The researchers assessed whether arthritis patients had low-, medium-

or high-activity disease, based on how long they had had the illness

and how swollen or tender their joints were. Then they looked at the

type of drug the patient was on.

The results: Those with medium disease activity had an eightfold rise

in their risk for lymphoma, compared with those with low activity.

Those with high activity disease had a 70-fold increase. The risk of

lymphoma also rose as the severity of the joint damage in hands,

knees and feet increased in the last year before the lymphoma was

diagnosed.

More than 70 percent of the rheumatoid arthritis patients studied had

taken anti-rheumatic drugs (DMARDS), including the drug methotrexate

(Trexall, Rheumatrex) , which had been linked by one French study to

increased risk of lymphomas. However, in this study, none of the

DMARDS were linked with an increase in lymphoma risk, nor were the

nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin or steroids.

In fact, the researchers noted that patients who received

corticosteroid injections in their inflamed joints were at

particularly low lymphoma risk, suggesting the drugs might help

protect against the cancer.

" This is good news for the majority of rheumatoid arthritis patients

without very severe disease, " Baecklund said. " And it is not so bad

news for those with severe disease either, as the results suggest

treatment may decrease the risk also in patients with severe disease.

It should hopefully support patients with arthritis to seek medical

care as early as possible and use anti-rheumatic treatment. "

" This study confirms our suspicions, " said . " The worse your

disease, the worse your complications and associated diseases. "

" We feel probably the best thing to do is aggressively treat the

disease and its inflammation, " he said. " By treating the disease and

the inflammation, we will decrease complications and other associated

diseases. If anything, we should be treating the inflammation more

aggressively, not less. "

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