Risk of Malignancy in Juvenile-Onset Arthritis (Brief Report)
DOI:
https://doi.org/10.12970/2310-9874.2016.04.01.2Keywords:
Juvenile idiopathic arthritis, standardized incidence ratio, cohort studies, malignancy, reviewAbstract
Objective: An increased risk for certain types of malignancies has been reported in rheumatoid arthritis (RA) patients. Comparable risks may exist in juvenile-onset arthritis due to its pathophysiological similarities with adult rheumatoid arthritis. Our objective was to investigate the relationship between juvenile-onset arthritis and risk of malignancy.
Methods: A systematic review of the published literature was performed. Articles reporting data concerning the observed cancer rates in patients with juvenile-onset arthritis versus the general population rates were further assessed. The standardized incidence ratios (SIR) of observed to expected cases were retrieved from the studies and pooled in order to determine the overall risk of malignancy in patients with juvenile-onset arthritis.
Results: The pooled SIR for overall cancer was 1.4 (95% Confidence Interval, CI 1.2-1.7). However, study data were not homogenous: certain studies showed a significantly increased risk of malignancy overall in juvenile-onset arthritis, but others showed that there was no significant increase in cancer risk overall. The pooled SIR for hematological malignancies was 1.7 (95% CI 1.2-2.4) across all studies.
Conclusions: Existing data on malignancy risk in juvenile-onset arthritis are conflicting. Additional data are needed in order to definitively establish the presence or absence of an association between juvenile-onset arthritis and cancer risk.
References
Lawrence RC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41(5): 778. http://dx.doi.org/10.1002/1529-0131(199805)41:5<778::AID-ART4>3.0.CO;2-V
Towner SR, et al. The epidemiology of juvenile arthritis in Rochester, Minnesota 1960-1979. Arthritis Rheum 1983; 26(10): 1208. http://dx.doi.org/10.1002/art.1780261006
Sullivan DB, Cassidy JT, Petty RE. Pathogenic implications of age of onset in juvenile rheumatoid arthritis. Arthritis Rheum 1975; 18(3): 251. http://dx.doi.org/10.1002/art.1780180309
Simon TA, et al. Incidence of malignancy in adult patients with rheumatoid arthritis: a meta-analysis. Arthritis Res Ther 2015; 17(1): 212. http://dx.doi.org/10.1186/s13075-015-0728-9
Mannion ML, Beukelman T. What is the Background Incidence of Malignancy in Children with Rheumatic Disease? Current Rheumatology Reports 2013; 15(3): 1-6. http://dx.doi.org/10.1007/s11926-012-0310-2
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62(10): 1006-12. http://dx.doi.org/10.1016/j.jclinepi.2009.06.005
Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology 2007; 18(6): 805-35. http://dx.doi.org/10.1097/EDE.0b013e3181577511
Breslow NE, Day NE. Statistical Methods in Cancer Research. Vol. II, The Design and Analysis of Cohort Studies (IARC Scientific Publication No. 82). Lyon, France: International Agency for Research on Cancer 1987.
Beukelman, et al. Rates of malignancy associated with juvenile idiopathic arthritis and its treatment. Arthritis Rheum 2012; 64(4): 1263-71. http://dx.doi.org/10.1002/art.34348
Kok VC, et al. Population-based cohort study on the risk of malignancy in East Asian children with juvenile idiopathic arthritis. BMC Cancer 2014; 14: 634. http://dx.doi.org/10.1186/1471-2407-14-634
Nordstrom BL, et al. Risk of malignancy in children with juvenile idiopathic arthritis not treated with biologic agents. Arthritis Care Res (Hoboken) 2012; 64(9): 1357-64. http://dx.doi.org/10.1002/acr.21709
Simard JH, et al. Juvenile idiopathic arthritis and risk of cancer: a nationwide cohort study. Arthritis Rheum 2010; 62(12): 3776-82. http://dx.doi.org/10.1002/art.27741
Thomas E, et al. Risk of malignancy among patients with rheumatic conditions. Int J Cancer. 2000; 88(3): 497-502. http://dx.doi.org/10.1002/1097-0215(20001101)88:3<497::AID-IJC27>3.0.CO;2-J
Zahedi Niaki O, et al. Malignancy incidence in 5294 patients with juvenile arthritis. RMD Open 2016; 2(1): e000212. http://dx.doi.org/10.1136/rmdopen-2015-000212
Koroukian, et al. Ability of Medicaid claims data to identify incident cases of breast cancer in the Ohio Medicaid population. Health Serv Res 2003; 38(3): 947-60. http://dx.doi.org/10.1111/1475-6773.00155
Stringer E, Bernatsky S. Validity of juvenile idiopathic arthritis diagnoses using administrative health data. Rheumatol Int 2015; 35(3): 575-9. http://dx.doi.org/10.1007/s00296-014-3142-8
Diak P, Siegel J, La Grenade L, Choi L, Lemery S, McMahon A. Tumor necrosis factor α blockers and malignancy in children: Forty-eight cases reported to the food and drug administration. Arthritis Rheum 2010; 62(8): 2517-2524. http://dx.doi.org/10.1002/art.27511
Cleary AG, McDowell H, Sills JA. Polyarticular juvenile idiopathic arthritis treated with methotrexate complicated by the development of non-Hodgkin's lymphoma. Arch Dis Child 2002; 86(1): 47-9. http://dx.doi.org/10.1136/adc.86.1.47
Baecklund E, et al. Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum 2006; 54(3): 692-701. http://dx.doi.org/10.1002/art.21675
Bongartz T, et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 2006; 295(19): 2275-85. http://dx.doi.org/10.1001/jama.295.19.2275
