RESEARCH - RA, treatment with corticosteroids, and risk of malignant lymphomas

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Ann Rheum Dis. 2009 May 12.

Rheumatoid arthritis, treatment with corticosteroids, and risk of

malignant lymphomas - results from a case-control study.

Hellgren K, Iliadou A, Rosenquist R, Feltelius N, Backlin C, Enblad G,

Askling J, Baecklund E.

Department of Medicine, Karolinska Institute, Sweden.

OBJECTIVE: Benefits and risks of corticosteroid treatment in

rheumatoid arthritis (RA) are debated. Patients with RA are at

increased risk of malignant lymphomas. In a large case-control study

of risk factors for lymphoma in RA, we recently reported that steroid

treatment was associated with decreased lymphoma risk. This study

sought to further assess the nature of this association.

METHODS: In a cohort of 74,651 patients with RA, we identified 378

cases with lymphoma and 378 matched RA controls, and abstracted

information on inflammatory activity and different aspects of steroid

treatment (duration, therapeutic strategy and mode of administration)

from their medical records. Lymphomas were reclassified (WHO

classification) and examined for Epstein-Barr virus. Relative risks

were assessed as adjusted odds ratios (OR) through conditional

logistic regression.

RESULTS: A total duration of oral steroid treatment less than two

years was not associated with lymphoma risk (OR=0.87; 95% confidence

interval [CI] 0.51-1.5), whereas total treatment longer than two years

was associated with a lower lymphoma risk (OR= 0.43; 95% CI

0.26-0.72). RA duration at the initiation of oral steroids did not

affect lymphoma risk. Intra-articular steroids were associated with a

reduced lymphoma risk, but only when used as swift flare therapy (OR=

0.22; 95% CI 0.13-0.37). Analyses by lymphoma subtype showed a reduced

risk of diffuse large B-cell lymphoma (crude OR=0.59; 95% CI

0.37-0.94).

CONCLUSION: In this RA population, use of steroids was associated with

reduced lymphoma risk. Whether this association is a generic effect of

steroids or specific to the studied population remains unknown.

PMID: 19439429

http://www.ncbi.nlm.nih.gov/pubmed/19439429

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