REVIEW - Incidence of lymphoma in patients with RA: a systematic review of the literature

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Clin Lymphoma Myeloma. 2008 Apr;8(2):87-93.

Incidence of lymphoma in patients with rheumatoid arthritis: a

systematic review of the literature.

Kaiser R.

Division of Rheumatology, University of California San Francisco, San

Francisco, CA 94143-0500, USA.

To our knowledge, this review is the most broad and only systematic

survey to date of the rheumatology, oncology, and epidemiology

literature to determine the prevalence of lymphoma in patients with

rheumatoid arthritis (RA). This survey is analyzed to determine

whether the association between RA and increased lymphoma risk is a

result of the risks conferred by medications used to treat RA or a

result of the disease itself. PubMed was searched for articles from

1964 to May 2007 using the Medical Subject Heading terms " arthritis,

rheumatoid, and lymphoma. " Twenty-six studies met inclusion and

exclusion criteria and are included for review. Most studies confirmed

an approximate 2-fold increase in lymphoma incidence in patients with

RA. Contrary to a widely held belief about medication toxicity in RA,

most studies did not reveal a statistically significant increased risk

of lymphoma with methotrexate or azathioprine. An increased lymphoma

incidence with tumor necrosis factor-alpha inhibitors was suggested;

however, follow-up in the studies considered was too short to

definitively determine increased risk. Most studies differed in which

medications they evaluated in determining their impact on lymphoma

risk, making studies difficult to compare. Confounding by disease

severity (patients with the most severe disease are treated with the

strongest medications) in most studies makes the association between

lymphoma risk and medications and/or disease severity difficult to

assess. Recent work suggests that it is the disease itself, not its

treatment, that is associated with increased risk of lymphoma in

patients with RA.

PMID: 18501101

http://www.ncbi.nlm.nih.gov/pubmed/18501101

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