Rheumatoid arthritis, treatment with corticosteroids and risk of malignant lymphomas: results from a case-control study.
BACKGROUND
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, it was recently reported that steroid treatment was associated with decreased lymphoma risk.


OBJECTIVE
To further assess the nature of the association between steroid treatment in RA and the risk of lymphoma.


METHODS
In a cohort of 74 651 patients with RA, 378 patients with lymphoma and 378 matched RA controls were identified, and information on inflammatory activity and different aspects of steroid treatment (duration, therapeutic strategy and mode of administration) abstracted from their medical records. Lymphomas were reclassified (WHO classification) and examined for Epstein-Barr virus. Relative risks were assessed as adjusted odds ratios (ORs) through conditional logistic regression.


RESULTS
A total duration of oral steroid treatment of <2 years was not associated with lymphoma risk (OR=0.87; 95% CI 0.51 to 1.5), whereas total treatment >2 years was associated with a lower lymphoma risk (OR=0.43; 95% CI 0.26 to 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 treatment (OR=0.22; 95% CI 0.13 to 0.37). Analyses by lymphoma subtype showed a reduced risk of diffuse large B-cell lymphoma (crude OR=0.59; 95% CI 0.37 to 0.94).


CONCLUSIONS
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.
Rheumatology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden. karin.hellgren@karolinska.se
Karin
K
Hellgren
Anastasia
A
Iliadou
Richard
R
Rosenquist
Nils
N
Feltelius
Carin
C
Backlin
Gunilla
G
Enblad
Johan
J
Askling
Eva
E
Baecklund
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007270:Injections, Intra-Articular; D008223:Lymphoma / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
D018501:Antirheumatic Agents; D005938:Glucocorticoids