Incidence and patterns of malignancies in a multi‐ethnic cohort of rheumatoid arthritis patients

Abstract

Aim This study was undertaken to determine the incidence and patterns of malignancies in rheumatoid arthritis (RA) patients in our cohort. Methods Between 2001 and 2013, we analyzed 1117 patients in the prospective Tan Tock Seng Hospital (TTSH) RA Registry. Patients who developed malignancies after the onset of RA were identified from this registry. Age‐ and sex‐adjusted standardized incidence ratios (SIRs) were calculated to compare observed to expected numbers of malignancies based on data from the Singapore Cancer Registry. Results Out of 19 839 person‐years of follow‐up, 132 incident malignancies were diagnosed during the observation period. There were 114 (86.4%) solid‐organ tumors and 18 (13.6%) hematological malignancies. The SIR (95% confidence interval) for all malignancies combined was 1.28 (0.88‐1.87) for males and 1.21 (1.00‐1.46) for females. Compared to the general population, we found a 4‐ to 5‐fold increase in lymphoma among our RA patients compared to the general population (SIR 5.05 [1.90‐13.46] for males and 3.75 [1.95‐7.20] for females). The SIR of lung malignancy in male RA patients is 2.36 (1.23‐4.53) and SIR of cervical malignancy in female RA patients is 3.72 (2.20‐6.23). Conclusion There is a trend toward an overall increased malignancy risk in our RA patients compared to the general population. Specifically, there is an increased risk of lymphomas in all RA patients, lung malignancy in male patients, and cervical malignancy in female patients, compared to the general population.

Association between Rheumatoid Arthritis Disease Activity and Risk of Ovarian Malignancy in Middle-Aged and Elderly Women

“…RA is a chronic inflammatory autoimmune disease. Studies have shown that patients with rheumatoid arthritis have an increased risk of cancer [ 2 – 5 , 39 ]. The long-term chronic inflammatory microenvironment, the secretion of immunosuppressive factors such as IL-10, abnormal autoimmune response, and the use of immunosuppressive drugs have led to frequent tumor-like symptoms and paraneoplastic syndromes in RA patients.…”

“…Studies have found that chronic inflammation caused by RA can induce malignant transformation of cells, and long-existing inflammatory mediators form a microenvironment that promotes cell mutagenesis and activates oncogenes [ 2 ]. The abnormal activation and proliferation of T lymphocytes, coupled with the frequent use of immunosuppressive drugs in RA patients, and autoimmune dysfunction affect the immune surveillance function and easily lead to immune escape, all of which increase the risk of tumors in RA patients [ 2 – 5 ]. In long-term clinical practice, we have found that RA patients are prone to increase in CA125 [ 6 , 7 ], especially in middle-aged and elderly women with high disease activity.…”

Effect of janus kinase inhibitors and methotrexate combination on malignancy in patients with rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials

“…Patients with RA are predisposed to a higher risk for malignancy [2][3][4][5][6][7]. It remains not entirely clear if the increased risk of malignancy is primarily related to the pathogenesis of the disease or due to the immunosuppressive therapy.…”

“…Rheumatoid arthritis (RA) is a systemic autoimmune disease, estimated to affect approximately 0.5% to 1% of population [1]. Patients with RA are predisposed to an increased risk for malignancy, especially malignant lymphomas [2][3][4][5][6][7], lung cancers [5,6] and non-melanoma skin cancer [7]. Higher mortality was associated with the presence of cancer, varied by stage of malignancy [8].…”

Two primary cancers: Primary squamous cell carcinoma with extensive ichthyosis uteri and cervical endometrioid carcinoma: A case report

“…Moreover, this patient had been taking methotrexate for several years as treatment for rheumatoid arthritis. The resulting immunocompromised state might have exacerbated the persistent inflammation, possibly contributing to the development of PSCCE (10).…”