Kaiser Rachel
Division of Rheumatology, University of California San Francisco, San Francisco, CA 94143-0500, USA.
Clin Lymphoma Myeloma. 2008 Apr;8(2):87-93. doi: 10.3816/CLM.2008.n.009.
To our knowledge, this review is the most broad and only systematic survey to date of the rheumatology, oncology, and epidemiology literature to determine the prevalence of lymphoma in patients with rheumatoid arthritis (RA). This survey is analyzed to determine whether the association between RA and increased lymphoma risk is a result of the risks conferred by medications used to treat RA or a result of the disease itself. PubMed was searched for articles from 1964 to May 2007 using the Medical Subject Heading terms "arthritis, rheumatoid, and lymphoma." Twenty-six studies met inclusion and exclusion criteria and are included for review. Most studies confirmed an approximate 2-fold increase in lymphoma incidence in patients with RA. Contrary to a widely held belief about medication toxicity in RA, most studies did not reveal a statistically significant increased risk of lymphoma with methotrexate or azathioprine. An increased lymphoma incidence with tumor necrosis factor-alpha inhibitors was suggested; however, follow-up in the studies considered was too short to definitively determine increased risk. Most studies differed in which medications they evaluated in determining their impact on lymphoma risk, making studies difficult to compare. Confounding by disease severity (patients with the most severe disease are treated with the strongest medications) in most studies makes the association between lymphoma risk and medications and/or disease severity difficult to assess. Recent work suggests that it is the disease itself, not its treatment, that is associated with increased risk of lymphoma in patients with RA.
据我们所知，本综述是迄今为止对风湿病学、肿瘤学和流行病学文献进行的最广泛且唯一的系统调查，旨在确定类风湿关节炎（RA）患者中淋巴瘤的患病率。对该调查进行分析，以确定RA与淋巴瘤风险增加之间的关联是用于治疗RA的药物所致风险的结果，还是疾病本身的结果。利用医学主题词“关节炎，类风湿性，和淋巴瘤”在PubMed中检索1964年至2007年5月的文章。26项研究符合纳入和排除标准并纳入综述。大多数研究证实RA患者淋巴瘤发病率约增加2倍。与关于RA药物毒性的广泛看法相反，大多数研究未发现使用甲氨蝶呤或硫唑嘌呤会使淋巴瘤风险有统计学上的显著增加。有研究提示肿瘤坏死因子-α抑制剂会使淋巴瘤发病率增加；然而，所纳入研究的随访时间过短，无法明确确定风险是否增加。大多数研究在评估对淋巴瘤风险的影响时所涉及的药物不同，导致研究难以比较。大多数研究中疾病严重程度造成的混杂因素（病情最严重的患者使用最强效的药物治疗）使得淋巴瘤风险与药物和/或疾病严重程度之间的关联难以评估。最近的研究表明，与RA患者淋巴瘤风险增加相关的是疾病本身，而非其治疗。
