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Journal of Peking University(Health Sciences) ›› 2018, Vol. 50 ›› Issue (6): 986-990. doi: 10.19723/j.issn.1671-167X.2018.06.008

• Article • Previous Articles     Next Articles

Clinical characteristic of 74 cases of malignant tumor in rheumatoid arthritis

Yu-hua WANG,Guo-hua ZHANG,Ling-ling ZHANG,Jun-li LUO,Lan GAO,Mian-song ZHAO()   

  1. Department of Rheumatology and Immunology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • Received:2018-07-06 Online:2018-12-18 Published:2018-12-18
  • Contact: Mian-song ZHAO E-mail:zmsdoctor@163.com
  • Supported by:
    Supported by Beijing National Science Foundation(7123220);Capital Medical University Research and Cultivation Fund PYZ(PYZ 2017039);Capital Medical University Foundation-Clinical Research Cooperation Fund(13JL64)

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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

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 2

RA and tumor occurrence time"

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
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