title: Incidence of malignancy and the risk of lymphoma in Japanese patients with rheumatoid arthritis compared to the general population.
abstract: OBJECTIVE
  Recent advances in the management of patients with rheumatoid arthritis (RA) increased the rates of disease remission and patient life expectancy, while malignancy has become a more common cause of death. Here, we report the incidence of malignancy in a nationwide survey of Japanese patients with RA compared to the general population, focusing on the risk of lymphoma, which often arises in patients with RA.
  
  
  METHODS
  Data on the occurrence of malignancy were collected from patients registered in a nationwide Japanese cohort database, the National Database of Rheumatic Diseases by iR-net in Japan, from 2003 to 2012. To adjust for different population composition and to compare the incidence of malignancy with the general population, standardized incidence rates (SIR) were calculated. To identify risk factors for lymphoma, individual patient data were obtained for multivariate analysis for the year before lymphoma diagnosis.
  
  
  RESULTS
  In 10 years, the cohort composed of 66,953 patient-years yielded 559 malignancies, most frequently lung cancer, followed by gastric cancer, breast cancer, and lymphoma. The overall incidence of malignancies in patients with RA was slightly lower than in the general population (SIR 0.89, 95% CI 0.82-0.97). However, lymphoma risk was significantly higher (SIR 3.43, 95% CI 2.59-4.28), whereas risk of colon, rectal, or liver cancer was lower. Significant risk factors for lymphoma were the use of methotrexate or tacrolimus, and higher age.
  
  
  CONCLUSIONS
  Patients with RA had no higher overall incidence of malignancies, but lymphoma was significantly more frequent than in the general population.
authors.affiliation: From the Department of Rheumatology, Department of Clinical Laboratory, and the Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital, National Hospital Organization, Sagamihara; Department of Rheumatology, Morioka National Hospital, Morioka; and the Nishino Orthopedic Clinic, Tokyo, Japan.A. Hashimoto, MD; T. Matsui, MD; Department of Rheumatology; H. Tsuno, MD; H. Furukawa, MD; S. Tohma, MD; Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology; A. Komiya, MD, Department of Clinical Laboratory, Sagamihara National Hospital, National Hospital Organization; N. Chiba, MD, Department of Rheumatology, Morioka National Hospital, National Hospital Organization; J. Nishino, MD, Nishino Orthopedic Clinic. a-hashimoto@sagamihara-hosp.gr.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hashimoto
authors.affiliation: From the Department of Rheumatology, Department of Clinical Laboratory, and the Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital, National Hospital Organization, Sagamihara; Department of Rheumatology, Morioka National Hospital, Morioka; and the Nishino Orthopedic Clinic, Tokyo, Japan.A. Hashimoto, MD; T. Matsui, MD; Department of Rheumatology; H. Tsuno, MD; H. Furukawa, MD; S. Tohma, MD; Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology; A. Komiya, MD, Department of Clinical Laboratory, Sagamihara National Hospital, National Hospital Organization; N. Chiba, MD, Department of Rheumatology, Morioka National Hospital, National Hospital Organization; J. Nishino, MD, Nishino Orthopedic Clinic.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Chiba
authors.affiliation: From the Department of Rheumatology, Department of Clinical Laboratory, and the Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital, National Hospital Organization, Sagamihara; Department of Rheumatology, Morioka National Hospital, Morioka; and the Nishino Orthopedic Clinic, Tokyo, Japan.A. Hashimoto, MD; T. Matsui, MD; Department of Rheumatology; H. Tsuno, MD; H. Furukawa, MD; S. Tohma, MD; Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology; A. Komiya, MD, Department of Clinical Laboratory, Sagamihara National Hospital, National Hospital Organization; N. Chiba, MD, Department of Rheumatology, Morioka National Hospital, National Hospital Organization; J. Nishino, MD, Nishino Orthopedic Clinic.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tsuno
authors.affiliation: From the Department of Rheumatology, Department of Clinical Laboratory, and the Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital, National Hospital Organization, Sagamihara; Department of Rheumatology, Morioka National Hospital, Morioka; and the Nishino Orthopedic Clinic, Tokyo, Japan.A. Hashimoto, MD; T. Matsui, MD; Department of Rheumatology; H. Tsuno, MD; H. Furukawa, MD; S. Tohma, MD; Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology; A. Komiya, MD, Department of Clinical Laboratory, Sagamihara National Hospital, National Hospital Organization; N. Chiba, MD, Department of Rheumatology, Morioka National Hospital, National Hospital Organization; J. Nishino, MD, Nishino Orthopedic Clinic.
authors.forename: Akiko
authors.initials: A
authors.lastname: Komiya
authors.affiliation: From the Department of Rheumatology, Department of Clinical Laboratory, and the Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital, National Hospital Organization, Sagamihara; Department of Rheumatology, Morioka National Hospital, Morioka; and the Nishino Orthopedic Clinic, Tokyo, Japan.A. Hashimoto, MD; T. Matsui, MD; Department of Rheumatology; H. Tsuno, MD; H. Furukawa, MD; S. Tohma, MD; Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology; A. Komiya, MD, Department of Clinical Laboratory, Sagamihara National Hospital, National Hospital Organization; N. Chiba, MD, Department of Rheumatology, Morioka National Hospital, National Hospital Organization; J. Nishino, MD, Nishino Orthopedic Clinic.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furukawa
authors.affiliation: From the Department of Rheumatology, Department of Clinical Laboratory, and the Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital, National Hospital Organization, Sagamihara; Department of Rheumatology, Morioka National Hospital, Morioka; and the Nishino Orthopedic Clinic, Tokyo, Japan.A. Hashimoto, MD; T. Matsui, MD; Department of Rheumatology; H. Tsuno, MD; H. Furukawa, MD; S. Tohma, MD; Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology; A. Komiya, MD, Department of Clinical Laboratory, Sagamihara National Hospital, National Hospital Organization; N. Chiba, MD, Department of Rheumatology, Morioka National Hospital, National Hospital Organization; J. Nishino, MD, Nishino Orthopedic Clinic.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Matsui
authors.affiliation: From the Department of Rheumatology, Department of Clinical Laboratory, and the Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital, National Hospital Organization, Sagamihara; Department of Rheumatology, Morioka National Hospital, Morioka; and the Nishino Orthopedic Clinic, Tokyo, Japan.A. Hashimoto, MD; T. Matsui, MD; Department of Rheumatology; H. Tsuno, MD; H. Furukawa, MD; S. Tohma, MD; Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology; A. Komiya, MD, Department of Clinical Laboratory, Sagamihara National Hospital, National Hospital Organization; N. Chiba, MD, Department of Rheumatology, Morioka National Hospital, National Hospital Organization; J. Nishino, MD, Nishino Orthopedic Clinic.
authors.forename: Jinju
authors.initials: J
authors.lastname: Nishino
authors.affiliation: From the Department of Rheumatology, Department of Clinical Laboratory, and the Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital, National Hospital Organization, Sagamihara; Department of Rheumatology, Morioka National Hospital, Morioka; and the Nishino Orthopedic Clinic, Tokyo, Japan.A. Hashimoto, MD; T. Matsui, MD; Department of Rheumatology; H. Tsuno, MD; H. Furukawa, MD; S. Tohma, MD; Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology; A. Komiya, MD, Department of Clinical Laboratory, Sagamihara National Hospital, National Hospital Organization; N. Chiba, MD, Department of Rheumatology, Morioka National Hospital, National Hospital Organization; J. Nishino, MD, Nishino Orthopedic Clinic.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Tohma
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008223:Lymphoma / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D012306:Risk
keywords: CANCER; EPIDEMIOLOGY; LYMPHOMA; METHOTREXATE; RHEUMATOID ARTHRITIS