title: Risk of malignancy associated with biologic agents in pediatric rheumatic disease.
abstract: OBJECTIVE
  The Food and Drug Administration report of an increased rate of malignancy among children treated with tumor necrosis factor inhibitors is worrisome. These concerns prompted rigorous studies of the incidence of malignancy associated with juvenile idiopathic arthritis, both with and without treatment with specific therapeutic agents. This article reviews studies of the risk of malignancy associated with biologic agents for the treatment of juvenile idiopathic arthritis and childhood-onset systemic lupus erythematosus.
  
  
  RESULTS
  Several studies demonstrated an increased background rate of malignancy associated with juvenile idiopathic arthritis, although the impact of medication use on the risk of malignancy was less clear. Similarly, childhood-onset systemic lupus erythematosus is likely associated with an increased malignancy risk, and the impact of biologic agents is unknown.
  
  
  CONCLUSIONS
  The diagnoses of juvenile idiopathic arthritis and childhood-onset systemic lupus erythematosus are likely associated with an increased background risk of malignancy, irrespective of medication use. Further studies to estimate the risks of malignancy associated with pediatric rheumatic diseases and their treatments are needed.
authors.affiliation: Division of Rheumatology, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Mannion
authors.forename: Timothy
authors.initials: T
authors.lastname: Beukelman
mesh_terms: D001171:Arthritis, Juvenile / Q000150:complications / Q000628:therapy; D001685:Biological Factors / Q000009:adverse effects*; D002648:Child; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000628:therapy; D009369:Neoplasms / Q000209:etiology*; D012216:Rheumatic Diseases / Q000150:complications / Q000628:therapy*; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D001685:Biological Factors; D014409:Tumor Necrosis Factor-alpha