Suguru Honda1, Ryoko Sakai1,2, Eisuke Inoue3, Masako Majima1, Naoko Konda1, Hideto Takada1, Mari Kihara4, Nobuyuki Yajima5,6,7, Toshihiro Nanki8, Kazuhiko Yamamoto9, Tsutomu Takeuchi10, Masayoshi Harigai1,2. 1. Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan. 2. Division of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases, Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan. 3. Showa University Research Administration Center, Showa University, Tokyo, Japan. 4. Department of Rheumatology, Tokyo Medical and Dental University, Tokyo, Japan. 5. Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan. 6. Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan. 7. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan. 8. Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan. 9. Riken Center for Integrative Medical Sciences, Saitama, Japan. 10. Department of Internal Medicine, Division of Rheumatology, School of Medicine, Keio University, Tokyo, Japan.
Abstract
OBJECTIVES: To investigate the risk factors and clinical characteristics of lymphoproliferative disorder (LPD) in Japanese patients with rheumatoid arthritis (RA). METHODS: We enrolled patients with RA aged ≥20 years who visited the participating hospitals between April 2011 and July 2011. We investigated the risk factors for LPD using a Cox proportional hazard model and described pathological features and vital prognosis of LPD in patients with RA. RESULTS: We enrolled 9815 patients with the following characteristics at baseline: female 79.4%, median age 63 years; median disease duration 7 years; median DAS28-CRP (3) 3.1; prevalence of MTX use 60.0%. Sixty-eight patients (0.69%) developed LPD in 3-year observation period. Multivariable analysis showed that age by decade (hazard ratio [95% confidence interval], 1.47 [1.18-1.85]) and MTX use at baseline (2.35 [1.25-4.42] for ≤8 mg/week, 4.39 [2.07-9.32] for >8 mg/week versus non-use) were significant risk factors of LPD. Of 55 patients with pathological diagnosis, diffuse large B cell lymphoma was the most frequent (54%). The 5-year mortality of LPD was 24%. The major cause of death was lymphoma (81%). CONCLUSION: This nationwide study revealed risk factors, clinical characteristics, and prognosis of LPD in the largest number of Japanese patients with RA.
OBJECTIVES: To investigate the risk factors and clinical characteristics of lymphoproliferative disorder (LPD) in Japanese patients with rheumatoid arthritis (RA). METHODS: We enrolled patients with RA aged ≥20 years who visited the participating hospitals between April 2011 and July 2011. We investigated the risk factors for LPD using a Cox proportional hazard model and described pathological features and vital prognosis of LPD in patients with RA. RESULTS: We enrolled 9815 patients with the following characteristics at baseline: female 79.4%, median age 63 years; median disease duration 7 years; median DAS28-CRP (3) 3.1; prevalence of MTX use 60.0%. Sixty-eight patients (0.69%) developed LPD in 3-year observation period. Multivariable analysis showed that age by decade (hazard ratio [95% confidence interval], 1.47 [1.18-1.85]) and MTX use at baseline (2.35 [1.25-4.42] for ≤8 mg/week, 4.39 [2.07-9.32] for >8 mg/week versus non-use) were significant risk factors of LPD. Of 55 patients with pathological diagnosis, diffuse large B cell lymphoma was the most frequent (54%). The 5-year mortality of LPD was 24%. The major cause of death was lymphoma (81%). CONCLUSION: This nationwide study revealed risk factors, clinical characteristics, and prognosis of LPD in the largest number of Japanese patients with RA.