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Risk of Lymphoma in Rheumatoid Arthritis Decreased by Long-term Steroid Use
June 20, 2007
Two years or more of oral steroid treatment decreases the risk of
rheumatoid arthritis (RA) related lymphoma, according to data presented
at the Annual European Congress of Rheumatology (EULAR). Furthermore,
these effects were found regardless of when in the course of the
disease the steroids were first administered. However, these beneficial
effects were not observed if the steroids were taken for less than a
two year period.
Study author Dr. Eva Baecklund of Uppsala University Hospital,
Sweden, said of the results, "The pros and cons of corticosteroid
treatment in rheumatoid arthritis have been a subject of much debate
and long term steroid treatment is often limited as a result of
concerns about various side effects. What our data show is a new aspect
of steroid treatment. Patients with severe rheumatoid arthritis are at
increased risk for malignant lymphomas, but long term steroid treatment
may decrease this risk."
In individuals treated with steroids for over two years, the
risk of rheumatoid arthritis-associated lymphomas was significantly
reduced (relative risk 0.4; 0.2 to 0.7), whilst less than two years of
steroids yielded no such reduced risk (relative risk 0.9; 0.5 to 1.5).
The most pronounced protective steroidal effect was observed in the
diffuse large B-cell lymphoma subtype - the type of lymphoma most
commonly associated with RA 1,2,3 with an odds ratio of 0.7 (0.4 to
The study involved 378 patients with
rheumatoid arthritis-associated lymphoma identified from the Swedish
Hospital Register and the Cancer Register compared with 378
individually matched RA controls, i.e. patients with RA but without
Using data on steroid treatment type and duration along
with inflammatory load collected from cases and controls, information
on lymphoma type (where observed) was also collected. The lymphoma
tissues were obtained from the pathology laboratories and were
reclassified according to the most recent lymphoma classification, the
World Health Organization classification.
Interestingly, researchers also compiled information on
the duration of RA at initiation of steroid treatment. In this study
there was no correlation observed between protective function and
length of RA at onset of steroidal treatment. The protective effect was
identical in those starting steroid treatment the first five years
after onset of RA and in those starting later (relative risk 0.6; 0.3
to 0.9). Steroid treatment outcome was not associated with the presence
of the Epstein-Barr virus in the lymphomas.
These results build on those of a previously published
study that reported that orally prescribed and intra-articular
(administered within the joint or joint cavity) steroids protect the
individual from the development of malignant lymphomas in a dose
SOURCE: The European League Against Rheumatism
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