[Link between rheumatoid arthritis and cancer].
Because it is a systemic disorder, rheumatoid arthritis (RA) is known to predispose affected individuals to other organ manifestations as well as arthritic problems. The serious complications include pericarditis, pulmonary and cutaneous nodules, episcleritis, and rheumatoid vasculitis. Of late, a significantly increased incidence of lymphoma has also accumulated. The overall risk is about double than in the general population, but that in patients with the most severe arthritis is dramatically higher. Men with RA appear to have an extremely elevated risk of Hodgkin's disease, which has also been observed at a higher incidence among the children of affected patients. These lymphomas are not typically infected with EBV, though RA patients have a defective capacity to control systemic EBV infection. Increasing attention is being paid to the effect of RA treatments on development of lymphoma, and some patients with EBV-positive tumors who have been taking methotrexate have shown a positive response after just discontinuing this drug. More controversial is the question of whether anti-TNF alpha agents involve an increased risk of lymphoma; in light of the conflicting evidence this matter is still unresolved.
Whelan
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Div. of Pediatric Rheumatology, Massachusetts General Hospital for Children, MGH Cancer Center and Harvard Medical School, USA. jwhelan@partners.org
D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology; D005260:Female; D006689:Hodgkin Disease / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D009369:Neoplasms / Q000453:epidemiology*; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate