Abstract
Rheumatoid arthritis (RA) patients have an increased risk of malignancy with postulated risk factors that include chronic inflammation, smoking and the use of immunosuppressants have been postulated as drivers of higher malignancies rates. Our study aimed to describe the prevalence and type of malignancies encountered in an urban, predominantly Black RA patient population. Cross sectional analysis of 1142 patients with RA diagnosis by ICD-codes of which 501 cases met the inclusion criteria for the study. Blacks accounted for 88.4% of the study population. Fifty-six patients had cancer recorded in their medical records and these cases were further reviewed for tumor type, timing of diagnosis and patient clinical characteristics. The cancer prevalence was 11.2% (56/501) in our Black RA population being studied. Mean age at cancer diagnosis was 59.9 ± 5.2 for the patients who developed cancer before RA diagnosis and 58.25 ± 16.02 for those who developed malignancy after RA diagnosis. There were 18 breast cancers, 4 colon and 4 cervical cancers; for lung, multiple myeloma, thyroid, squamous cell carcinoma and pancreas there were 3 cases each; for endometrial, Non-Hodgkin's lymphoma, meningioma and prostate, 2 cases each and 1 each for urinary bladder, esophageal adenocarcinoma, lymphoma, glioblastoma, liver, Hodgkin's lymphoma, sarcoma, ovary and renal cell carcinoma. No differences were found in years of RA duration, joint erosion, joint space narrowing or SENS score except for significantly higher ESR among the cancer group and RF seropositivity in the non-cancer group.Therapeutic modalities were not significantly different between the cancer and no cancer groups. Breast cancer was the most prevalent malignancy among our Black RA population. Further studies are needed to identify the contributing factors to the malignancy risk of breast cancer in our Black RA population and whether it is gender-related since RA is more prevalence in women.
Highlights
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by proliferating synovitis, cartilage damage and juxta-articular bone destruction that results in joint deformities and functional disability [1]
No significant differences were found in patient comorbidities, smoking rates, clinical characteristics, medication patterns between the cancer and non-cancer groups
While the etiology of RA is multifactorial with a complex interplay of environmental and genetic factors, the pathogenesis is rooted in chronic, systemic inflammatory activation and over activation of the adaptive and innate immune responses [1]
Summary
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by proliferating synovitis, cartilage damage and juxta-articular bone destruction that results in joint deformities and functional disability [1]. While the etiology of RA is multifactorial with a complex interplay of environmental and genetic factors, the pathogenesis is rooted in chronic, systemic inflammatory activation and over activation of the adaptive and innate immune responses [1]. Inflammation is fundamental to the neoplastic process, whereby inflammatory cells are essential for tumor development, via increased cell proliferation, angiogenesis, evasion of the adaptive immune response, and facilitation of metastasis [4]. Numerous follow-up studies including single-center retrospective cohort studies as well as meta-analyses have corroborated Isomaki’s findings and expanded on his initial work, showing increased risk of lung cancer and lymphomas and a decreased incidence of colon and breast cancer among patients with RA [6]
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