合并恶性肿瘤的类风湿关节炎74例

doi:10.19723/j.issn.1671-167X.2018.06.008

摘要/Abstract

摘要：

目的: 对合并恶性肿瘤的类风湿关节炎患者74例的临床特征进行分析。方法: 回顾总结首都医科大学附属北京世纪坛医院2011年1月至2017年6月住院治疗的1 562例类风湿关节炎患者,对其中74例类风湿关节炎合并恶性肿瘤的患者的一般情况、所患肿瘤类型、类风湿关节炎和肿瘤起病顺序、用药情况等进行分析。结果: 类风湿关节炎患者恶性肿瘤的发病率为4.16%,74例患者中女性53例,男性21例。类风湿关节炎发病时年龄(52.6 ± 17.8) 岁,肿瘤确诊时年龄(63.4±12.7)岁。类风湿关节炎起病时间早于恶性肿瘤者51例(51/74),时间间隔2~60年,平均(17.2±14.2)年;恶性肿瘤发病早于类风湿关节炎者16例(16/74),时间间隔1~21年,平均(6.2±5.9)年,其中10例为性激素相关的肿瘤;二者同时发病7例(7/74),两者发生时间间隔在1年以内,7例均为RA先诊断,年龄均在60岁以上,且均为消化道肿瘤。肿瘤类型以胃肠道肿瘤、乳腺癌和生殖系统肿瘤最常见;其次为呼吸系统肿瘤、泌尿系统肿瘤和血液系统肿瘤。结论: 类风湿关节炎患者合并恶性肿瘤的风险增加,病情活动、药物的使用、雌激素及吸烟等是可能的危险因素,因此所有类风湿关节炎患者在诊断时均要进行恶性肿瘤筛查,诊断后要进行恶性肿瘤监测。

关键词: 类风湿关节炎, 恶性肿瘤, 恶性肿瘤监测

Abstract:

Objective: To investigate the clinical characteristics of rheumatoid arthritis (RA) patients with malignant tumor.Methods:Retrospective summary was made of 1 562 in patients of RA from January 2011 to June 2017.In the study, 74 RA patients with malignant tumor were reviewed and analyzed, and the general conditions, tumor types, RA and tumor onset sequence, and the medication situation were analyzed.Results:The incidence of malignant tumor in the patients with rheumatoid arthritis in our center was 4.16 %. The 74 patients were complicated with malignant tumor, of whom 53 were female,and 21 male. The age of RA at presentation was (52.6±17.8) years. The average disease duration of malignant tumor was (63.4 ± 12.7) years. The onset time of rheumatoid arthritis was earlier than that of malignant tumors in 51 cases (51/74), with an average of (17.2±14.2) years between 2 and 60 years. The incidence of malignant tumor was earlier than that of rheumatoid arthritis in 16 cases (16/74), with an average of (6.2±5.9) years between 1 and 21 years, of which 10 cases were sex hormone related tumors. Seven cases (7/74) were diagnosed with RA at the same time, and the time interval between the two diseases was within 1 year. All the patients were over 60 years old with digestive tract tumors. All the 7 patients showed polyarthritis, significantly increased erythrocyte sedimentation rate and C-reactive protein, including 4 rheumatoid factor positive cases and 2 anti-CCP antibody positive cases. The effect of non-steroidal anti-inflammatory drugs and traditional drugs to improve the condition of the disease was poor in the 7 patients, and the condition was relieved after using low-dose glucocorticoids. Gastrointestinal tumors, breast and reproductive system tumors were the most common, followed by respiratory, urological and blood system tumors.Conclusion:The risk in patients of rheumatoid arthritis complicated with malignant tumor is higher than that of the general population. A variety of factors play an important role in cancer risk of RA, including disease activity, some estrogen metabolites, the use of drugs and so on. Therefore, all RA patients should be screened for malignant tumor during diagnosis, and malignant tumor surveillance is mandatory for all rheumatoid arthritis patients after diagnosis.

Key words: Rheumatoid arthritis, Malignant tumor, Malignant tumor surveillance

中图分类号:

R593.22

王玉华,张国华,张令令,罗俊丽,高兰,赵绵松. 合并恶性肿瘤的类风湿关节炎74例[J]. 北京大学学报（医学版）, 2018, 50(6): 986-990.

Yu-hua WANG,Guo-hua ZHANG,Ling-ling ZHANG,Jun-li LUO,Lan GAO,Mian-song ZHAO. Clinical characteristic of 74 cases of malignant tumor in rheumatoid arthritis[J]. Journal of Peking University(Health Sciences), 2018, 50(6): 986-990.

图/表 2

表1

类风湿关节炎合并恶性肿瘤的主要资料"

Tumor site	Case	Tumor diagnosis age/years, $x -$ ±s	RA diagnosis age/years, $x -$ ±s	Smoking history, n	Tumor onset before/ concurring with/after RA onset
Breast	17	61.6±12.8	59.6±10.4	0	8/0/9
Colorectal	10	64.3±12.7	58.8±19.6	5	4/0/6
Lung	9	73.3±10.1	52.0±21.9	3	0/0/9
Esophagus	5	63.2±7.3	45.2±9.4	1	0/1/4
Lymphoma	5	65.8±14.1	53.6±24.9	0	1/0/4
Prostate	4	73.3±3.4	69.5±7.5	2	1/1/2
Endometrium	3	38.3±27.0	53.3±12.7	0	1/0/2
Pancreas	3	69.3±5.5	62.7±7.1	1	0/2/1
Thyroid	3	44.7±1.5	26.7±3.8	0	0/0/3
Stomach	2	69.0±14.1	47.5±16.3	0	0/1/1
Liver	2	76.0±8.5	57.5±21.9	1	0/0/2
Ovary	2	49.0±12.7	22.0±14.1	0	0/0/2
Biliary duct	1	64	63	0	0/1/0
Cholecyst	1	59	59	0	0/1/0
Periampullar	1	57	32	0	0/0/1
Meninges	1	57	47	0	0/0/1
Glioblastoma	1	61	44	0	0/0/1
Cervical	1	50	37	0	0/0/1
Peritoneal	1	74	55	0	0/0/1
Kidney	1	59	53	0	0/0/1
Testis	1	31	41	1	1/0/0

表1

表2

参考文献 21

[1]	Simon TA, Thompson A, Gandhi KK , et al. Incidence of malignancy in adult patients with rheumatoid arthritis: a meta-analysis[J]. Arthritis Res Ther, 2015,17:212. doi: 10.1186/s13075-015-0728-9 pmid: 18433475
[2]	Turesson C, Matteson EL . Malignancy as a comorbidity in rheumatic diseases[J]. Rheumatology (Oxford), 2013,52(1):5-14. doi: 10.1093/rheumatology/kes189 pmid: 22829694
[3]	Gridley G , McLaughlin JK, Ekbom A, et al. Incidence of cancer among patients with rheumatoid arthritis[J]. J Natl Cancer Inst, 1993,85(4):307-311. doi: 10.1093/jnci/85.4.307 pmid: 8426374
[4]	Askling J, Fored CM, Brandt L , et al. Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumor necrosis factor antagonists[J]. Ann Rheum Dis, 2005,64(10):1421-1426. doi: 10.1136/ard.2004.033993 pmid: 1005157
[5]	Smitten AL, Simon TA, Hochberg MC , et al. A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis[J]. Arthritis Res Ther, 2008,10(2):R45. doi: 10.1186/ar2404 pmid: 18433475
[6]	Parikh-Patel A, White RH, Allen M , et al. Risk of cancer among rheumatoid arthritis patients in California[J]. Cancer Causes Control, 2009,20(6):1001-1010. doi: 10.1007/s10552-009-9298-y pmid: 19184473
[7]	Raheel S, Crowson CS, Wright K , et al. Risk of Malignant neoplasm in patients with incident rheumatoid arthritis 1980 -2007 in relation to a comparator cohort: a population-based study [J/OL]. Int J Rheumatol, https: //www.hindawi.com/journals/ijr/2016/4609486/.
[8]	Chen W, Zheng R, Baade PD , et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016,66(2):115-132. doi: 10.3322/caac.21338 pmid: 26808342
[9]	Ometto F, Fedeli U, Schievano E , et al. Cause-specific mortality in a large population-based cohort of patients with rheumatoid arthritis in Italy[J]. Clin Exp Rheumatol, 2018,36(4):636-642 pmid: 29533757
[10]	Pedersen JK, Holst R, Primdahl J , et al. Mortality and its predictors in patients with rheumatoid arthritis: a Danish population-based inception cohort study[J]. Scand J Rheumatol, 2018,47(5):371-377. doi: 10.1080/03009742.2017.1420223 pmid: 29741136
[11]	Manger B, Schett G . Rheumatic paraneoplastic syndromes: a clin-ical link between malignancy and autoimmunity[J]. Clin Immunol, 2018,186:67-70. doi: 10.1016/j.clim.2017.07.021 pmid: 28736272
[12]	Wen J, Ouyang H, Yang R , et al. Malignancy dominated with rheumatic manifestations: a retrospective single-center analysis[J]. Sci Rep, 2018,8(1):1786. doi: 10.1038/s41598-018-20167-w pmid: 5789019
[13]	Wilton KM, Matteson EL . Malignancy incidence, management and prevention in patients with rheumatoid arthritis[J]. Rheumatol Ther, 2017,4(2):333-347. doi: 10.1007/s40744-017-0064-4 pmid: 28508282
[14]	Chiu YM, Lang HC, Lin HY , et al. Risk of tuberculosis, serious infection and lymphoma with disease-modifying biologic drugs in rheumatoid arthritis patients in Taiwan[J]. Int J Rheum Dis, 2014,17(3):9-19. doi: 10.1111/1756-185X.12539 pmid: 25496045
[15]	Harigai M, Nanki T, Koike R , et al. Risk for malignancy in rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs compared to the general population: a nationwide cohort study in Japan[J]. Mod Rheumatol, 2016,26(5):642-650. doi: 10.3109/14397595.2016.1141740 pmid: 26873430
[16]	Mercer LK, Askling J, Raaschou P , et al. Risk of invasive melanoma in patients with rheumatoid arthritis treated with biologics: results from a collaborative project of 11 European biologic registers[J]. Ann Rheum Dis, 2017,76(2):386-391. doi: 10.1136/annrheumdis-2016-209285 pmid: 5284347
[17]	Wadstr?m H, Frisell T, Askling J , et al. Malignant neoplasms in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors, tocilizumab, abatacept, or rituximab in clinical practice a nationwide cohort study from Sweden[J]. JAMA Intern Med, 2017,177(11):1605-1612. doi: 10.1001/jamainternmed.2017.4332 pmid: 28975211
[18]	Mercer LK, Galloway JB, Lunt M , et al. Risk of lymphoma in patients exposed to antitumour necrosis factor therapy: results from the British society for rheumatology biologics register for rheumatoid arthritis[J]. Ann Rheum Dis, 2017,76(3):497-503. doi: 10.1136/annrheumdis-2016-209389 pmid: 24685910
[19]	de La Forest Divonne M, Gottenberg JE, Salliot C . Safety of biologic DMARDs in RA patients in real life: a systematic literature review and meta-analyses of biologic registers[J]. Joint Bone Spine, 2017,84(2):133-140. doi: 10.1016/j.jbspin.2016.02.028 pmid: 27341745
[20]	Khan WA, Khan MW . Cancer morbidity in rheumatoid arthritis: role of estrogen metabolites [J/OL]. Biomed Res Int, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3789363/.
[21]	Joseph RM, Movahedi M, Dixon WG , et al. Smoking-related mortality in patients with early rheumatoid arthritis: a retrospective cohort study using the clinical practice research datalink[J]. Arthritis Care Res (Hoboken), 2016,68(11):1598-1606. doi: 10.1002/acr.22882 pmid: 26990778

相关文章 15

[1]	刘东武, 陈杰, 高明利, 于静. 类风湿关节炎伴发淋巴结Castleman样病理改变1例[J]. 北京大学学报（医学版）, 2024, 56(5): 928-931.
[2]	黄会娜,赵静,赵祥格,白自然,李霞,王冠. 乳酸对类风湿关节炎患者外周血CD4⁺T细胞亚群的调控作用[J]. 北京大学学报（医学版）, 2024, 56(3): 519-525.
[3]	汤晓菲,李永红,丁秋玲,孙卓,张阳,王育梅,田美伊,刘坚. 类风湿关节炎患者下肢深静脉血栓发病率及危险因素[J]. 北京大学学报（医学版）, 2024, 56(2): 279-283.
[4]	邹雪,白小娟,张丽卿. 艾拉莫德联合托法替布治疗难治性中重度类风湿关节炎的疗效[J]. 北京大学学报（医学版）, 2023, 55(6): 1013-1021.
[5]	吴琦,蔡月明,何娟,黄文蒂,王庆文. 血脂异常与类风湿关节炎肺间质病变的相关性分析[J]. 北京大学学报（医学版）, 2023, 55(6): 982-992.
[6]	张警丰,金银姬,魏慧,姚中强,赵金霞. 体重指数与类风湿关节炎临床特征的相关性分析[J]. 北京大学学报（医学版）, 2023, 55(6): 993-999.
[7]	金银姬,孙琳,赵金霞,刘湘源. 血清IgA型抗鼠科肉瘤病毒癌基因同源物B1抗体在类风湿关节炎中的意义[J]. 北京大学学报（医学版）, 2023, 55(4): 631-635.
[8]	蔡文心,李仕成,刘一鸣,梁如玉,李静,郭建萍,胡凡磊,孙晓麟,李春,刘栩,叶华,邓立宗,李茹,栗占国. 类风湿关节炎临床分层及其特征的横断面研究[J]. 北京大学学报（医学版）, 2022, 54(6): 1068-1073.
[9]	程昉,杨邵英,房星星,王璇,赵福涛. CCL28-CCR10通路在类风湿关节炎单核细胞迁移中的作用[J]. 北京大学学报（医学版）, 2022, 54(6): 1074-1078.
[10]	刘蕊,赵金霞,闫良. 类风湿关节炎合并下肢静脉血栓患者的临床特点[J]. 北京大学学报（医学版）, 2022, 54(6): 1079-1085.
[11]	张警丰,金银姬,魏慧,姚中强,赵金霞. 类风湿关节炎患者生活质量与疾病活动度的横断面研究[J]. 北京大学学报（医学版）, 2022, 54(6): 1086-1093.
[12]	柯杨,王敏敏,刘萌飞,刘芳芳,刘英,何忠虎. 肿瘤早期预警生物标志物的研究与思考[J]. 北京大学学报（医学版）, 2022, 54(5): 810-813.
[13]	马芮,宣岩,段瑶,帅婷. 口腔颌面部恶性肿瘤患者术后正念水平调查及影响因素分析[J]. 北京大学学报（医学版）, 2022, 54(4): 727-734.
[14]	高超,陈立红,王莉,姚鸿,黄晓玮,贾语博,刘田. 类风湿关节炎合并纤维肌痛简易分类标准的临床验证[J]. 北京大学学报（医学版）, 2022, 54(2): 278-282.
[15]	娄雪,廖莉,李兴珺,王楠,刘爽,崔若玫,徐健. 类风湿关节炎患者外周血TWEAK基因启动子区甲基化状态及其表达[J]. 北京大学学报（医学版）, 2021, 53(6): 1020-1025.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

General information	RA onset before tumor	RA and tumor occured simultaneously	RA onset after tumor
Number of cases	51	7	16
Male :female	14 :37	3 :4	4 :12
Time interval/years	17.2±14.2	0.5±0.3	6.2±5.9
Tumor types and case number	Breast/lung 9, colorectal 6, esophagus/lymphoma 4, thyroid 3, prostate/endometrium/liver/ovary 2, pancreas/stomach/periampul- lar/meninges/glioblastoma/cer-vical/peritoneal 1	Pancreas 2, esophagus/prostate/ stomach/biliary duct/cholecyst 1	Breast 8, colorectal 4, lymphoma/ prostate/endometrium/testis 1