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Risk Of Lymphoma In RA Sufferers Decreased By Long-term Treatment With Steroids
June 14, 2007
Two years or more of oral steroid treatment decreases the risk of
rheumatoid arthritis (RA) related lymphoma, according to data presented
today at EULAR 2007, the Annual European Congress of Rheumatology, in
Barcelona, Spain. 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 (cancer in the immune system), 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; 0.2-0.7), whilst less than two years of steroids
yielded no such reduced risk (relative risk 0.9; 0.5-1.5). 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 (0.4-1.0).
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 lymphoma.
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
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;
0.3-0.9). 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 (actively cancerous)
lymphomas in a dose responsive manner.1
1.Baecklund E, et al. Association of chronic inflammation, not its
treatment, with increased lymphoma risk in rheumatoid arthritis.
Arthritis Rheum 2006;54:692-701.
This research: Abstract number: OPO047
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