Rheumatology, University of Washington, Seattle, Washington, USA
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.
RMD Open. 2020 Jul;6(2). doi: 10.1136/rmdopen-2020-001241.
Past epidemiological studies have consistently demonstrated a link between rheumatoid arthritis (RA) and the incidence of lymphoma and it has been posited that high systemic inflammatory activity is a major risk determinant of lymphomagenesis. Given advances in the therapeutic armamentarium for RA management in recent years, the resulting lower level of disease activity could have led to a decline in lymphoma incidence in patients with RA. This study examined recent trends in lymphoma incidence in US veterans with RA.
Patients with RA were identified in the Veterans Affairs (VA) Corporate Data Warehouse. Lymphoma incidence was identified through the end of 2018 from the VA Central Cancer Registry and compared among patients diagnosed during 2003-2005, 2006-2008, 2009-2011 and 2012-2014.
Among persons diagnosed with RA during 2003-2005, the incidence of lymphoma in the next 6 years was 2.0 per 1000 person-years. There was a steady decline in lymphoma incidence during the corresponding 6 years following diagnosis in the subsequent three cohorts, with a rate of 1.5 per 1000 person-years in the 2012-2014 cohort (incidence relative to that in the 2003-2005 cohort=0.79 (95% CI 0.58 to 1.1)). There was no similar decline in lymphoma incidence in VA patients diagnosed with osteoarthritis.
We observed a decline in lymphoma incidence in recent years among American veterans with RA. Further studies are needed to evaluate the specific factors driving this decline.
过去的流行病学研究一致表明类风湿关节炎（RA）与淋巴瘤的发病率之间存在关联，并且有人提出全身性炎症活动度高是淋巴瘤发生的主要危险因素。鉴于近年来 RA 治疗手段的进步，疾病活动度的降低可能导致 RA 患者淋巴瘤发病率的下降。本研究调查了美国退伍军人 RA 患者淋巴瘤发病率的近期趋势。
在退伍军人事务部（VA）企业数据仓库中确定了 RA 患者。通过 VA 中央癌症登记处确定淋巴瘤的发病率，并在 2003-2005 年、2006-2008 年、2009-2011 年和 2012-2014 年诊断的患者中进行比较。
在 2003-2005 年期间诊断为 RA 的患者中，接下来 6 年的淋巴瘤发病率为每 1000 人年 2.0 例。在随后的三个队列中，在诊断后的相应 6 年内，淋巴瘤发病率稳步下降，2012-2014 年队列的发病率为每 1000 人年 1.5 例（发病率与 2003-2005 年队列相比=0.79（95%CI 0.58 至 1.1））。在被诊断为骨关节炎的 VA 患者中，淋巴瘤发病率没有类似的下降。
我们观察到近年来美国退伍军人 RA 患者淋巴瘤发病率下降。需要进一步研究评估推动这一下降的具体因素。
