title: Risk of non-melanoma skin cancer in a national cohort of veterans with rheumatoid arthritis.
abstract: OBJECTIVE
  To determine the incidence of and risk factors for non-melanoma skin cancer (NMSC) in a national cohort of veterans with RA.
  
  
  METHODS
  We examined skin cancer risk in a cohort of 20 648 patients with RA derived from the Department of Veterans' Affairs (VA) national administrative databases. The cohort was divided into two medication groups: patients treated with non-biologic and TNF-α antagonist DMARDs. We defined skin cancer as the first occurrence of an International Classification of Disease, Version 9, Clinical Modification (ICD-9-CM) code for NMSC after initiation of a DMARD. Outcome risk was described using hazard ratios (HRs) with Cox proportional hazards regression for time-to-event analysis and logistic regression. We performed medical record review to validate the diagnosis of NMSC.
  
  
  RESULTS
  Incidence of NMSC was 18.9 and 12.7 per 1000 patient-years in patients on TNF-α antagonists and non-biologic DMARDs, respectively. Patients on TNF-α antagonists had a higher risk of developing NMSC (HR 1.42; 95% CI 1.24, 1.63). Risk factors for NMSC included older age, male gender, NSAID and glucocorticoid use and a history of prior malignancies. There was substantial agreement between ICD-9-CM diagnosis of NMSC and medical record validation (κ = 0.61).
  
  
  CONCLUSIONS
  TNF-α antagonist therapy in veterans with RA may be associated with an increased risk of NMSC, compared with therapy with non-biologic DMARDs. Rheumatologists should carefully screen patients receiving TNF-α antagonists for pre-cancerous skin lesions and skin cancer.
authors.affiliation: Department of Medicine, Division of Rheumatology, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Wassila
authors.initials: W
authors.lastname: Amari
authors.forename: Angelique L
authors.initials: AL
authors.lastname: Zeringue
authors.forename: Jay R
authors.initials: JR
authors.lastname: McDonald
authors.forename: Liron
authors.initials: L
authors.lastname: Caplan
authors.forename: Seth A
authors.initials: SA
authors.lastname: Eisen
authors.forename: Prabha
authors.initials: P
authors.lastname: Ranganathan
mesh_terms: D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000473:pathology; D002280:Basal Cell Carcinoma / Q000453:epidemiology* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology; D014481:United States / Q000453:epidemiology; D058014:Veterans Health / Q000706:statistics & numerical data