title: Risk of malignancy in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis under immunosuppressive therapy: a single-center experience.
abstract: Systemic inflammatory rheumatic diseases are associated with an increased risk of malignancy, in particular of lymphoproliferative disorders. Chronic inflammation, due to the disease itself, generates a microenvironment able to promote cancer development, but it is still controversial whether immunosuppressive therapy may contribute to carcinogenesis. The aim of the study was to evaluate the risk of malignancy in 399 patients affected by rheumatoid arthritis (RA), psoriatic arthritis and ankylosing spondylitis, all treated with either tumor necrosis factor α-inhibitors plus disease-modifying anti-rheumatic drugs (DMARDs) or DMARDs alone. The risk of malignancy in this cohort of patients, observed in the period between 2005 and 2011 at S. Andrea Hospital-Sapienza University of Rome, was compared with that of the general Italian population, matched for age, sex, and area of residence. Fourteen (3.5%) malignancies, five of which were hematologic, have been observed. The overall cancer risk was not significantly increased in comparison to the general population, whereas the risk of hematologic malignancies appeared significantly higher in RA patients (SIR 4.94, 95% CI 1.35-12.64), particularly in female gender (SIR 6.9, 0.95% CI 1.88-17.66). No significant association between therapy and malignancy was demonstrated in RA patients.
authors.affiliation: Unit of Allergy and Immuno-Rheumatology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy. martafanto@gmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: Fantò
authors.affiliation: Centre for Health and Veterinarian Research, Italian Army, Rome, Italy.
authors.forename: Mario Stefano
authors.initials: MS
authors.lastname: Peragallo
authors.affiliation: Unit of Allergy and Immuno-Rheumatology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Pietrosanti
authors.affiliation: Unit of Allergy and Immuno-Rheumatology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Di Rosa
authors.affiliation: Unit of Allergy and Immuno-Rheumatology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Picchianti Diamanti
authors.affiliation: Unit of Allergy and Immuno-Rheumatology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Salemi
authors.affiliation: Unit of Allergy and Immuno-Rheumatology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy. raffaele.damelio@gmail.com.
authors.forename: Raffaele
authors.initials: R
authors.lastname: D'Amelio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Ankylosing spondylitis; Disease-modifying anti-rheumatic drugs; Malignancies; Psoriatic arthritis; Rheumatoid arthritis; Tumor necrosis factor α-inhibitors