The age–risk relationship of hematologic malignancies in patients with rheumatoid arthritis: a nationwide retrospective cohort study
- 346 Downloads
The risk of hematologic malignancies in rheumatoid arthritis (RA) patients has been an important clinical concern. The information of age effect on the interval from the diagnosis of RA to that of hematologic malignancies is limited. This study aimed to define the age–risk relationship between hematologic malignancies and RA. A retrospective cohort study was conducted nationwide with 17,472 patients and 87,360 controls from the Taiwan National Health Insurance Database covering 1997–2008. The subsequent development of hematologic malignancy was observed. The age-adjusted standardized incidence ratios (SIRs), incidence per 1000 person-years, follow-up duration for the diagnosis of hematologic malignancies, and cumulative hazard rates of hematologic malignancies between RA and controls were analyzed. Significantly higher incidences of both lymphoid and myeloid malignancies were found in male RA patients compared with RA-free patients (SIR 3.36, 95 % CI = 2.03–5.57, and SIR: 3.69, 95 % CI = 2.46–5.53). A significantly increased overall incidence risk was found in lymphoid malignancies (SIR 3.00, 95 % CI = 2.22–4.05) but not significantly increased in myeloid malignancies (SIR 1.54, 95 % CI = 0.95–2.50) in female RA. The follow-up duration for hematologic malignancies was significantly shorter in RA patients than in RA-free patients in both males and females (70.70 vs. 103.80 months and 67.73 vs. 100.93 months, respectively). Additionally, higher cumulative hazard rates in both lymphoid and myeloid malignancies were found in male RA patients (p < 0.0001). RA patients have a shorter incubation time to hematological malignancies while comparing to the RA-free people, and the risks are variable in gender and different age groups.
KeywordsAge risk Autoimmune disease Cancer Hematologic malignancy Rheumatoid arthritis
The authors thank the help from the Statistical Analysis Laboratory, Department of Internal Medicine, Kaohsiung Medical University Hospital. This study was supported by a grant from Kaohsiung Medical University Hospital (KMUH101-1 M20).
- 10.Askling J, Baecklund E, Granath F, Geborek P, Fored M, Backlin C, Bertilsson L, Coster L, Jacobsson LT, Lindblad S, Lysholm J, Rantapaa-Dahlqvist S, Saxne T, van Vollenhoven R, Klareskog L, Feltelius N (2009) Anti-tumour necrosis factor therapy in rheumatoid arthritis and risk of malignant lymphomas: relative risks and time trends in the Swedish Biologics Register. Ann Rheum Dis 68(5):648–653PubMedCrossRefGoogle Scholar
- 11.Mariette X, Matucci-Cerinic M, Pavelka K, Taylor P, van Vollenhoven R, Heatley R, Walsh C, Lawson R, Reynolds A, Emery P (2011) Malignancies associated with tumour necrosis factor inhibitors in registries and prospective observational studies: a systematic review and meta-analysis. Ann Rheum Dis 70(11):1895–1904PubMedCrossRefGoogle Scholar
- 16.Kamel OW, van de Rijn M, Weiss LM, Del Zoppo GJ, Hench PK, Robbins BA, Montgomery PG, Warnke RA, Dorfman RF (1993) Reversible lymphomas associated with Epstein-Barr virus occurring during methotrexate therapy for rheumatoid arthritis and dermatomyositis. N Engl J Med 328(18):1317–1321PubMedCrossRefGoogle Scholar
- 27.Marie I, Guillevin L, Menard JF, Hatron PY, Cherin P, Amoura Z, Cacoub P, Bachelez H, Buzyn A, Le Roux G, Ziza JM, Brice P, Munck JN, Sarrot-Reynauld F, Piette JC, Larroche C (2012) Hematological malignancy associated with polymyositis and dermatomyositis. Autoimmun Rev 11(9):615–620PubMedCrossRefGoogle Scholar