June 15, 2007 (Barcelona) — Patients with rheumatoid arthritis (RA) who are treated on a long-term basis with corticosteroids are less likely to develop lymphoma, according to a team of Swedish investigators who presented their findings here at the annual European Congress of Rheumatology (EULAR).
"There are many patients who hesitate to use steroids because of their known side effects," said principal investigator Eva Baecklund, MD, from the department of rheumatology, Uppsala University Hospital, in Sweden, in her presentation. "This study adds a new, positive aspect to steroid treatment in RA." Dr. Baecklund noted that this finding is important because the incidence of lymphoma is increasing among patients with RA.
She and her coinvestigators wanted to know more about this beneficial link because their previous research had shown that treatment with corticosteroids was associated with a reduced risk for lymphoma. Therefore, in a case-control study nested within the Swedish Hospital Inpatient Register, they identified 424 cases of lymphoma among 74,651 RA patients, and 424 individually matched RA controls. The investigators identified the cases in the Swedish Cancer Register between 1965 and 1996. Dr. Baecklund and her team also collected clinical data, including inflammatory load and steroid treatment from the medical records of cases and controls, from which they identified all lymphomas. The final analysis consisted of 378 cases and 378 controls.
Among the patients, 183 cases (48%) and 217 controls (57%) received at least 4 weeks of treatment with oral corticosteroids for RA; 168 cases (44%) and 240 controls (63%) received intra-articular steroids at flares.
The investigators found that oral steroid treatment that lasted less than 2 years was not associated with an increase or decrease in the risk for lymphoma, with a relative risk (RR) of 0.9. However, among patients whose total treatment with corticosteroids lasted longer than 2 years, the RR was 0.4, a marked reduction.
Interestingly, the duration of RA at the time that oral steroid treatment first began did not change the protective effect of steroids on lymphoma risk. Among those who had had RA for less than 5 years at the time steroid treatment was begun, the RR was 0.6. For those who had lived with RA for at least 5 years, the RR was unchanged. The investigators found that the protective effect of steroids was more pronounced for diffuse large B-cell lymphomas, with an odds ratio (OR) of 0.7, compared with all other subtypes. The investigators found no association between steroid treatment and the presence of Epstein-Barr virus in the lymphomas. Therefore, concerns about the risk for lymphoma should not limit long-term treatment of RA patients with oral steroids, the investigators concluded.
This presentation spoke to the fact that there are many patients who do not tolerate disease-modifying anti-rheumatoid drugs and biological agents," said Tore Kvien, MD, president of EULAR and a professor of rheumatology at Diakonhjammet Hospital, in Oslo, Norway, in an interview with Medscape. "It's important to remember that corticosteroids have a beneficial effect." Dr. Kvien was not involved in the study.
"Lymphoma is not a common complication of RA but it is a known compilation," he said. "Knowing that steroids can reduce the risk is important. Reducing the inflammatory activity, a property of corticosteroid treatment, may have wide-ranging implications in the management of RA," he said.
EULAR 2007: Abstract OP0047. Presented June 14, 2007.
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