Rheumatoid arthritis drugs wont increase risk of lymphoma

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Rheumatoid arthritis drugs wont increase risk of lymphoma

Post by Mike Bartolatz »

Rheumatoid Arthritis Drugs Won't Boost Lymphoma Risk 02.27.06 [Link]

Excerpted from the March issue of Arthritis & Rheumatism.

Experts have long known that rheumatoid arthritis boosts the risk for lymphoma, but the reason for this connection has remained unclear. Now, Swedish research suggests it isn't due to the treatments for the disease, as some had feared. Instead, chronic inflammation linked to illness appears to be the culprit, with cancer risk rising as the arthritis worsens.

According to experts, this means that drugs that keep rheumatoid inflammation to a minimum may be crucial in curbing both the arthritis and its associated lymphoma risk.
"What this study is showing is, not only is there not a cause-effect relationship with treatment [and lymphomas], but the cause and effect is really with the severity of the disease," said Dr. Hayes Wilson, national medical advisor for the Arthritis Foundation and chief of rheumatology at Piedmont Hospital in Atlanta. He was not involved in the study, which appears in the March issue of Arthritis & Rheumatism.

Rheumatoid arthritis is a chronic disease, marked by inflammation of the lining of the joints. Over time, the disease can cause long-term joint damage, chronic pain, immobility and disability. About 2 million Americans have rheumatoid arthritis, according to the Arthritis Foundation. A variety of medications are used to treat the disease, including nonsteroidal anti-inflammatory drugs (NSAIDs), other analgesic drugs, prednisone, disease-modifying anti-rheumatic drugs and newer "biologic-response modifiers," which directly modify the immune system.

"The major concern and the common interpretation of earlier reports and studies have been that the drugs used to treat rheumatoid arthritis also leads to increased lymphoma risk," explained study co-author Dr. Eva Baecklund, of University Hospital in Uppsala.

However, "reading the existing medical literature critically, I would say that results have been conflicting," Baecklund said, adding that no specific drug has ever been linked to increased lymphoma risk.

In their study, Baecklund's team evaluated the records of nearly 75,000 rheumatoid arthritis patients, zeroing in on 378 patients who also developed lymphoma. They then compared those patients to 378 healthy controls.

The researchers assessed whether arthritis patients had low-, medium- or high-activity disease, based on how long they had had the illness and how swollen or tender their joints were. Then they looked at the type of drug the patient was on.

The results: Those with medium disease activity had an eightfold rise in their risk for lymphoma, compared with those with low activity. Those with high activity disease had a 70-fold increase. The risk of lymphoma also rose as the severity of the joint damage in hands, knees and feet increased in the last year before the lymphoma was diagnosed.

More than 70 percent of the rheumatoid arthritis patients studied had Taken anti-rheumatic drugs (DMARDS), including the drug methotrexate (Trexall,Rheumatrex) , which had been linked by one French study to increased risk of lymphomas. However, in this study, none of the DMARDS were linked with an increase in lymphoma risk, nor were the nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin or steroids. In fact, the researchers noted that patients who received corticosteroid injections in their inflamed joints were at particularly low lymphoma risk, suggesting the drugs might help protect against the cancer.

"This is good news for the majority of rheumatoid arthritis patients without very severe disease," Baecklund said. "And it is not so bad news for those with severe disease either, as the results suggest treatment may decrease the risk also in patients with severe disease. It should hopefully support patients with arthritis to seek medical care as early as possible and use anti-rheumatic treatment."

"This study confirms our suspicions," said Wilson. "The worse your disease, the worse your complications and associated diseases."

"We feel probably the best thing to do is aggressively treat the disease and its inflammation," he said. "By treating the disease and the inflammation, we will decrease complications and other associated diseases. If anything, we should be treating the inflammation more aggressively, not less."

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Mike Bartolatz