Computed tomography for malignancy screening in patients with rheumatoid arthritis before initiation of disease modifying antirheumatic drug

Abstract

Objectives This study aimed to clarify the usefulness of screening for malignancies using computed tomography (CT) before the initiation of biologics and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in patients with active rheumatoid arthritis (RA). Methods We examined 2,192 patients with RA who underwent plain CT scans prior to the initiation of b/tsDMARDs. The sensitivity for detecting malignancy was measured and compared with that of Regular screening (physical examination and X-ray). We then evaluated the clinical characteristics, prognosis, and treatment of patients with RA with concomitant malignancies. Additionally, we determined the incidence rate of malignancy in patients with RA who were initiated b/tsDMARDs after CT screening. Results Of the 2,192 patients, 33 (1.5%) were diagnosed with malignancy after CT screening. Whereas regular screening detected only 7 malignancies, CT screening further detected 26 (including 19 at the early stage). On the other hand, 86% of the malignancies detectable by regular screening were at advanced stage. Patients diagnosed with early-stage malignancies received RA treatments that included b/tsDMARDs after curative resection; 80% of these patients achieved low disease activity after 1 year. This rate was comparable of the patients without malignancy detection after screening (70%). The 5 years-incidence of malignancy after the initiation of b/tsDMARDs after CT screening was lower to that of RA cohort without CT screening (standardized incidence ratio: 0.35). Conclusion Screening in patients with RA using CT before the initiation of b/tsDMARDs allows for the early detection and treatment of malignancy, resulting in safer and more stable b/tsDMARD treatments.

Prognosis and prognostic factors of lung cancer complications in patients with rheumatoid arthritis

“…The United States Preventive Services Task Force recommends yearly screening tests by chest CT for those in the 50–80 age groups with 20‐pack‐year smoking histories and those who are currently smoking or within 15 years of quitting 25 . Miyata et al 26 . performed CT screening on 2192 patients with RA who required the introduction of biological or targeted synthetic DMARDs and reported that 15 had lung cancer.…”

“…performed CT screening on 2192 patients with RA who required the introduction of biological or targeted synthetic DMARDs and reported that 15 had lung cancer. Furthermore, 80% of patients with RA and lung cancer had stage I disease, and curative resection was performed in all cases, indicating that CT screening was useful for the early detection of lung cancer, even in patients with RA with high disease activity 26 . Considering that the incidence of lung cancer in patients with RA is higher than that in the general population, annual chest CT screening is mandatory for those with a history of smoking.…”

“…As shown in and those who are currently smoking or within 15 years of quitting. 25 Miyata et al 26 performed CT screening on 2192 patients with RA who required the introduction of biological or targeted synthetic DMARDs and reported that 15 had lung cancer. Furthermore, 80% of patients with RA and lung cancer had stage I disease, and curative resection was performed in all cases, indicating that CT screening was useful for the early detection of lung cancer, even in patients with RA with high disease activity.…”

“…Furthermore, 80% of patients with RA and lung cancer had stage I disease, and curative resection was performed in all cases, indicating that CT screening was useful for the early detection of lung cancer, even in patients with RA with high disease activity. 26 Considering that the incidence of lung cancer in patients…”

A Machine Learning Approach for Prediction of CDAI Remission with TNF Inhibitors: A Concept of Precision Medicine from the FIRST Registry

“…Patients who met the ACR/EULAR 2010 RA classification criteria and did not respond to phase I therapy were referred to UOEH for further evaluation of eligibility for b/tsDMARDs. This comprehensive evaluation included assessment of contraindications and consideration of comorbidities, such as screening for infectious diseases and malignancies [ 23 ]. Subsequently, the administration of the b/tsDMARDs was decided by the patients and the treating physician under the guidance of recommendations/guidelines [ 1 , 2 , 24 ].…”