A chapter from HANDLING THE HARD QUESTIONS:
What Our Patients Are Asking Us About Rheumatic Disease
Read and download this booklet on our Workforce Resource homepage
Each day, rheumatology nurses, nurse practitioners, and physician assistants field dozens of questions from their patients with rheumatic diseases, and they need to be able to properly and effectively communicate appropriate responses. This pocket guide includes a brief summary of evidence surrounding some of the most common—and challenging—questions that patients with rheumatoid arthritis, psoriatic arthritis, gout, and systemic lupus erythematosus are asking about. We hope you find this guide useful for your professional development and that it assists you with your day-to-day patient management.
Will the medications I may be prescribed for my Rheumatoid Arthritis (RA) increase my risk of getting cancer?
It is unlikely, although the relationship between RA and cancer is complicated.
Compared with the general population, individuals with RA have a slightly elevated baseline risk of developing certain types of cancers, in particular lymphoma and lung cancer. Researchers believe that the elevated risk of lymphoma and lung cancer is likely the consequence of a chronically activated immune system, especially given that people with poorly-controlled RA appear to be at the highest risk for developing lymphoma.1 However, it is important to remember that the overall malignancy risk in individuals with RA is only modestly increased (~10%) compared with the general population.2 As such, a diagnosis of RA does not mean cancer will ultimately develop.
Despite significant research, it is not yet clear whether RA itself is responsible for the increased cancer risk, if medications used to treat RA affect the risk of malignancy, or if it is a combination of both factors.2
DMARDs form the backbone of treatment for RA. These therapies work through targeting and modifying immunologic pathways involved in the development of RA.2 Data from early studies raised concerns that the use of DMARD therapy, in particular biologics, may increase the risk of malignancies in patients with RA.3 However, robust analyses of more recent data suggest that methotrexate, biologic DMARDs, and synthetic DMARDs are not associated with an overall increased risk for malignancies.1,4-7
For instance, recent data from a large (~125,000 patients) collaborative project that pooled data from 11 registries in 9 European countries found no evidence that biologic DMARDs increase the risk of lymphoma and malignant melanoma beyond the normal background risk in patients with RA.1,3 Similarly, patients receiving biologic DMARDs do not appear to be at increased risk for solid cancers (e.g., breast, lung, colorectal cancers) and non-melanoma skin cancers compared to those treated with conventional DMARDs.7
Such findings can be reassuring to patients as the benefits of DMARD therapy for reducing disease activity likely outweigh the risk of treatment-related malignancy.
1. Mercer LK, Regierer AC, Mariette X, et al. Spectrum of lymphomas across different drug treatment groups in rheumatoid arthritis: a European registries collaborative project. Ann Rheum Dis. 2017;76(12):2025-2030.
2. Simon TA, Thompson A, Gandhi KK, Hochberg MC, Suissa S. Incidence of malignancy in adult patients with rheumatoid arthritis: a meta-analysis. Arthritis Res Ther. 2015;17:212.
3. Mercer LK, Askling J, Raaschou P, et al. Risk of invasive melanoma in patients with rheumatoid arthritis treated with biologics: results from a collaborative project of 11 European biologic registers. Ann Rheum Dis. 2017;76(2):386-391.
4. Mercer LK, Galloway JB, Lunt M, et al. Risk of lymphoma in patients exposed to antitumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Ann Rheum Dis. 2017;76(3):497-503.
5. Wilton KM, Matteson EL. Malignancy incidence, management, and prevention in patients with rheumatoid arthritis. Rheumatol Ther. 2017;4(2):333-347.
6. Wadstrom H, Frisell T, Askling J, Anti-Rheumatic therapy in Sweden Study G. Malignant neoplasms in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors, tocilizumab, abatacept, or rituximab in clinical practice: A nationwide cohort study from Sweden. JAMA Int Med. 2017;177(11):1605-1612.
7. Ramiro S, Sepriano A, Chatzidionysiou K, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis. 2017;76(6):1101-1136.