Skin cancer, rheumatoid arthritis, and tumor necrosis factor inhibitors

[Guest guest]

J Rheumatol. 2005 Nov;32(11):2130-5.

Skin cancer, rheumatoid arthritis, and tumor necrosis factor inhibitors.

Chakravarty EF, Michaud K, Wolfe F.

From the Division of Immunology and Rheumatology, Stanford

University School of Medicine, Palo Alto, California; the National

Data Bank for Rheumatic Diseases; and the University of Kansas School

of Medicine, Wichita, Kansas, USA.

OBJECTIVE: To determine the rates of reported non-melanoma skin

cancer (NMSC) in a large cohort of patients with rheumatoid arthritis

(RA) in comparison to patients with osteoarthritis (OA) and to

determine risk factors for the development of NMSC in patients with

RA. METHODS: Self-reported information from 15,789 patients with RA

and 3,639 patients with OA were collected through semi-annual

questionnaires since 1999. Survival analyses were used to determine

incidence rates for NMSC among patients with RA and OA. Multivariate

proportional hazard models were used to estimate hazard ratios

(HR) for the development of NMSC. Separate analyses were performed

for patients with RA to explore associations between use of

immunosuppressive medication and development of NMSC. RESULTS: The

crude (unadjusted) incidence rate for reported NMSC among patients

with RA and OA were 18.1 and 20.4 per 1000 patient years,

respectively. OA patients were older, more likely to be Caucasian,

and had higher past incidence of NMSC. Age, male sex, Caucasian race,

and history of NMSC prior to entry into the database were associated

with an increased risk of NMSC in multivariate proportional

hazard models. After adjustment for covariates, RA was associated

with an increased risk of NMSC (HR 1.19, p = 0.042). Among RA

patients, the development of NMSC was associated with use of

prednisone (HR 1.28, p = 0.014) and tumor necrosis factor (TNF)

inhibitors alone or with concomitant methotrexate (HR 1.24, p = 0.89

and HR 1.97, p = 0.001, respectively) in addition to established risk

factors including fair skin, age, male sex, and previous history of

NMSC. No association was found between use of methotrexate or

leflunomide and development of NMSC (HR 1.12, p = 0.471, HR 0.83, p =

0.173, respectively). CONCLUSION: In this large, national cohort, RA

was associated with an increased risk for development of NMSC. Among

patients with RA, use of TNF inhibitors and prednisone were

associated with an increased risk of NMSC.

PMID: 16265690 [PubMed - in process]