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Meta-Analysis
. 2008;10(2):R45.
doi: 10.1186/ar2404. Epub 2008 Apr 23.

A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis

Allison L Smitten  1 , Teresa A Simon, Marc C Hochberg, Samy Suissa
Affiliations
Meta-Analysis

A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis

Allison L Smitten et al. Arthritis Res Ther. 2008.

Abstract

Introduction: The risk of malignancies in patients with rheumatoid arthritis (RA) has raised some concern, particularly with immunosuppressive approaches to disease management.

Methods: We conducted a systematic review of the literature and meta-analysis characterizing the associated risk of overall malignancy and four site-specific malignancies (lymphoma, lung, colorectal, and breast cancer) in patients with RA. A Medline search from 1990 to 2007 was conducted using specified search terms and predefined inclusion criteria for identification of relevant observational studies that provide estimates of relative risk of malignancy associated with RA. Study-specific estimates of the relative risk, as measured by standardized incidence ratios (SIRs) and estimated in comparison with the general population, were combined using a random effects model.

Results: A total of 21 publications were identified, of which 13 reported the SIR for overall malignancy, 14 for lymphoma, 10 for colorectal, 12 for lung, and 9 for breast cancer. Compared with the general population, the overall SIR estimates suggest that RA patients have approximately a two-fold increase in lymphoma risk (SIR 2.08, 95% confidence interval [CI] 1.80 to 2.39) and greater risk of Hodgkin than non-Hodgkin lymphoma. The risk of lung cancer was also increased with an SIR of 1.63 (95% CI 1.43 to 1.87). In contrast, a decrease in risk was observed for colorectal (SIR 0.77, 95% CI 0.65 to 0.90) and breast (SIR 0.84, 95% CI 0.79 to 0.90) cancer. The SIR for overall malignancy was 1.05 (95% CI 1.01 to 1.09).

Conclusion: Patients with RA appear to be at higher risk of lymphoma and lung cancer and potentially decreased risk for colorectal and breast cancer compared with the general population.

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Figures

Figure 1
Figure 1
Relative risk of overall lymphoma in patients with rheumatoid arthritis (RA) compared with the general population. CI, confidence interval; n, number of malignancies; N, population size; SIR, standardized incidence ratio; TNF, tumor necrosis factor.
Figure 2
Figure 2
Relative risk of Hodgkin disease in patients with rheumatoid arthritis compared with the general population. CI, confidence interval; MTX, methotrexate; n, number of malignancies; N, population size; SIR, standardized incidence ratio.
Figure 3
Figure 3
Relative risk of non-Hodgkin lymphoma in patients with rheumatoid arthritis compared with the general population. CI, confidence interval; DMARDs, disease-modifying antirheumatic drugs; MTX, methotrexate; n, number of malignancies; N, population size; SIR, standardized incidence ratio.
Figure 4
Figure 4
Relative risk of lung cancer in patients with rheumatoid arthritis (RA) compared with the general population. CI, confidence interval; DMARDs, disease-modifying antirheumatic drugs; MTX, methotrexate; n, number of malignancies; N, population size; SIR, standardized incidence ratio; TNF, tumor necrosis factor.
Figure 5
Figure 5
Relative risk of colorectal cancer in patients with rheumatoid arthritis (RA) compared with the general population. CI, confidence interval; DMARDs, disease-modifying antirheumatic drugs; MTX, methotrexate; n, number of malignancies; N, population size; SIR, standardized incidence ratio; TNF, tumor necrosis factor.
Figure 6
Figure 6
Relative risk of breast cancer in patients with rheumatoid arthritis (RA) compared with the general population. CI, confidence interval; DMARDs, disease-modifying antirheumatic drugs; MTX, methotrexate; n, number of malignancies; N, population size; SIR, standardized incidence ratio; TNF, tumor necrosis factor.
Figure 7
Figure 7
Relative risk of overall malignancies in patients with rheumatoid arthritis (RA) compared with the general population. *Excluding non-melanoma skin; †all solid tumors; ‡excluding lymphatic and hematopoetic. CI, confidence interval; DMARDs, disease-modifying antirheumatic drugs; MTX, methotrexate; n, number of malignancies; N, population size; SIR, standardized incidence ratio; TNF, tumor necrosis factor.
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