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

Abstract

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

CLC Number:

R593.22

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.

Figures/Tables 2

Table 1

Main clinical features of RA combined with malignant tumor"

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

Table 1

Table 2

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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

Clinical characteristic of 74 cases of malignant tumor in rheumatoid arthritis

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