A patient with rheumatoid arthritis may develop a non-Hodgkin lymphoma. Smedby et al listed factors associated with increased risk for this complication. The authors are from Karolinska Institute in Stockholm.


Autoimmune diseases associated with an increased risk of non-Hodgkin lymphoma:

(1) rheumatoid arthritis

(2) primary Sjogren syndrome

(3) systemic lupus erythematosus

(4) celiac disease


Most common types of non-Hodgkin lymphoma in patients with RA:

(1) diffuse large B-cell lymphoma

(2) T-cell lymphoma

(3) lymphoplasmacytic lymphoma


Risk factors in rheumatoid arthritis:

(1) daily treatment for > 4 weeks (not associated with local corticosteroid injections or intermittent use of NSAIDS)

(2) disease duration 6 to 20 years

(3) any impairment to activities of daily living

(4) history of hospital discharge with rheumatoid arthritis


Treatment history associated with an increased risk:

(1) long-term NSAID therapy

(2) therapy of immunosuppressants (methotrexate, azathioprine, cyclosporine, cyclosphosphamidie, chlorambucil)

(3) use of immunosuppressants for > 4 years


It is unclear if the occurrence of malignant lymphoma in patients treated with new targeted therapies is related to that therapy or simply reflects the increased risk associated with severe rheumatoid arthritis.


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