Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.

<h4>Background</h4>Several studies have demonstrated an association between rheumatoid arthritis (RA) and lymphoproliferative malignancies, but pathogenic mechanisms remain unclear. We investigated 1) the risk of lymphoproliferative malignancies and solid tumors in adults with RA identif...

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Autores principales:	Christen Lykkegaard Andersen, Hanne Lindegaard, Hanne Vestergaard, Volkert Dirk Siersma, Hans Carl Hasselbalch, Niels de Fine Olivarius, Ole Weis Bjerrum, Peter Junker
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7747e2bb342f4cf8abb080a5f4fc85d5
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spelling	oai:doaj.org-article:7747e2bb342f4cf8abb080a5f4fc85d52021-11-18T08:16:25ZRisk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.1932-620310.1371/journal.pone.0099388https://doaj.org/article/7747e2bb342f4cf8abb080a5f4fc85d52014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24914777/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Several studies have demonstrated an association between rheumatoid arthritis (RA) and lymphoproliferative malignancies, but pathogenic mechanisms remain unclear. We investigated 1) the risk of lymphoproliferative malignancies and solid tumors in adults with RA identified in primary care and 2) the possible mediating role of blood eosinophilia in the clonal evolution of cancer in these patients.<h4>Methods</h4>From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count between 2000-2007. From these, one DIFF was randomly chosen (the index DIFF). By linking to the Danish National Patient Register, we categorized the selected individuals according to known longstanding (≥3 years) or recent onset (<3 years) RA prior to the index DIFF. In addition, the cohort was stratified according to management in primary or secondary care. From the Danish Cancer Registry we ascertained malignancies within four years following the index DIFF. Using multivariable logistic regression, odds ratios (OR) were calculated and adjusted for sex, age, year, month, eosinophilia, comorbid conditions and C-reactive protein (CRP).<h4>Results</h4>921 patients had recent onset RA and 2,578 had longer disease duration. Seventy three percent of RA patients were managed in primary care. After adjustment for sex, age, year, and month, neither recent onset nor long-standing RA was associated with incident lymphoproliferative malignancies or solid cancers. These risk estimates did not change when eosinophilia, CRP, and comorbidities were included in the models.<h4>Conclusions</h4>In this large cohort of patients with RA of short or long duration recruited from a primary care resource, RA was not associated with an increased risk of lymphoproliferative or solid cancers during 4 years of follow-up, when the models were adjusted for confounders. Blood eosinophilia could not be identified as a mediator of cancer development in the present setting.Christen Lykkegaard AndersenHanne LindegaardHanne VestergaardVolkert Dirk SiersmaHans Carl HasselbalchNiels de Fine OlivariusOle Weis BjerrumPeter JunkerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 6, p e99388 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Christen Lykkegaard Andersen Hanne Lindegaard Hanne Vestergaard Volkert Dirk Siersma Hans Carl Hasselbalch Niels de Fine Olivarius Ole Weis Bjerrum Peter Junker Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.
description	<h4>Background</h4>Several studies have demonstrated an association between rheumatoid arthritis (RA) and lymphoproliferative malignancies, but pathogenic mechanisms remain unclear. We investigated 1) the risk of lymphoproliferative malignancies and solid tumors in adults with RA identified in primary care and 2) the possible mediating role of blood eosinophilia in the clonal evolution of cancer in these patients.<h4>Methods</h4>From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count between 2000-2007. From these, one DIFF was randomly chosen (the index DIFF). By linking to the Danish National Patient Register, we categorized the selected individuals according to known longstanding (≥3 years) or recent onset (<3 years) RA prior to the index DIFF. In addition, the cohort was stratified according to management in primary or secondary care. From the Danish Cancer Registry we ascertained malignancies within four years following the index DIFF. Using multivariable logistic regression, odds ratios (OR) were calculated and adjusted for sex, age, year, month, eosinophilia, comorbid conditions and C-reactive protein (CRP).<h4>Results</h4>921 patients had recent onset RA and 2,578 had longer disease duration. Seventy three percent of RA patients were managed in primary care. After adjustment for sex, age, year, and month, neither recent onset nor long-standing RA was associated with incident lymphoproliferative malignancies or solid cancers. These risk estimates did not change when eosinophilia, CRP, and comorbidities were included in the models.<h4>Conclusions</h4>In this large cohort of patients with RA of short or long duration recruited from a primary care resource, RA was not associated with an increased risk of lymphoproliferative or solid cancers during 4 years of follow-up, when the models were adjusted for confounders. Blood eosinophilia could not be identified as a mediator of cancer development in the present setting.
format	article
author	Christen Lykkegaard Andersen Hanne Lindegaard Hanne Vestergaard Volkert Dirk Siersma Hans Carl Hasselbalch Niels de Fine Olivarius Ole Weis Bjerrum Peter Junker
author_facet	Christen Lykkegaard Andersen Hanne Lindegaard Hanne Vestergaard Volkert Dirk Siersma Hans Carl Hasselbalch Niels de Fine Olivarius Ole Weis Bjerrum Peter Junker
author_sort	Christen Lykkegaard Andersen
title	Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.
title_short	Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.
title_full	Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.
title_fullStr	Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.
title_full_unstemmed	Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.
title_sort	risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/7747e2bb342f4cf8abb080a5f4fc85d5
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Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting.

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