Wednesday, July 18, 2012

Rheumatoid Arthritis Patients Have a Higher Risk of Developing Cancer

Persons with rheumatoid arthritis have daily struggles with severe pain and movement. Another serious downfall of the disorder is that these patients are more susceptible to develop cancer.

The association between rheumatoid arthritis (RA) and cancer is not completely clear. Some studies show an increased risk of cancer in people with rheumatoid arthritis (RA) while others show a decreased risk. But the picture becomes clearer when researchers look at specific cancer types.
Lymphoma. The strongest evidence of a link appears to be between lymphoma -- the most common type of blood cancer -- and severe rheumatoid arthritis (RA). Researchers from Sweden examined data from nearly 75,000 RA patients, 378 of whom had lymphoma. The researchers assessed risk for three different levels of disease activity (low, moderate, and severe) and found that people with moderate disease activity were eight times more likely to have lymphoma than those who had low disease activity, while those with severe disease activity were 70 times more likely.
More support for a connection comes from a review of 21 published studies, including the Swedish study and 13 others that tried to determine whether there was a link between lymphoma and rheumatoid arthritis (RA). The findings, reported recently in Arthritis Research & Therapy,showed that overall, people with rheumatoid arthritis (RA) were twice as likely as the general population to develop lymphoma, particularly Hodgkin's lymphoma (one of the most curable types of cancer when detected early).
Lung cancer. The same review also reported that lung cancer was observed more often in people with rheumatoid arthritis (RA). Based on data from 12 studies, people with rheumatoid arthritis (RA) were 63% more likely to develop lung cancer than the general population.
Cancer at other sites. In addition, the authors of the review reported a potentially reduced risk of colorectal cancer among people with rheumatoid arthritis (RA) -- possibly due to their increased use of nonsteroidal antiinflammatory drugs (NSAIDs) and COX-2 inhibitors. The researchers also reported a slightly reduced risk of breast cancer.
What's Behind the Link? An important question that remains unanswered is whether people with rheumatoid arthritis (RA) are more prone to develop certain cancers than others or if the medications they take could be responsible for the increased risk.
In the Swedish study, more than 70% of people with rheumatoid arthritis (RA) had taken traditional disease-modifying antirheumatic drugs, or DMARDs, such as methotrexate (Rheumatrex, Trexall). However, the only DMARD linked to an increased risk of lymphoma was azathioprine (Imuran) -- a treatment that is rarely used today. There was also no link between NSAIDs like aspirin and ibuprofen (Advil and others).
One encouraging finding was that people who frequently used corticosteroids for inflamed joints had a lower risk of lymphoma, a result that suggests anti-inflammatory drugs could possibly protect against lymphoma.

Kimme L. Hyrich,M.D.,Arthritis Research UK Epidemiology Unit at University of Manchester discusses the risk of rheumatoid arthritis patients.

All RA patients should be regularly tested for cancer.  All health care professionals should be aware of this risk and write orders so they can be screened. If you know anyone with RA please ask and encourage them to be tested.  Early detection can save a life.

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