Article

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
Expand
  • Department of Rheumatology and Immunology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China

Received date: 2018-07-06

  Online published: 2018-12-18

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)

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.

Cite this article

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

References

[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.
[2] Turesson C, Matteson EL . Malignancy as a comorbidity in rheumatic diseases[J]. Rheumatology (Oxford), 2013,52(1):5-14.
[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.
[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.
[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.
[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.
[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.
[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
[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.
[11] Manger B, Schett G . Rheumatic paraneoplastic syndromes: a clin-ical link between malignancy and autoimmunity[J]. Clin Immunol, 2018,186:67-70.
[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.
[13] Wilton KM, Matteson EL . Malignancy incidence, management and prevention in patients with rheumatoid arthritis[J]. Rheumatol Ther, 2017,4(2):333-347.
[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.
[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.
[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.
[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.
[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.
[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.
[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.
Outlines

/