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Patients with rheumatoid arthritis (RA) are at increased risk of lymphoma,1–4 and anti-tumour necrosis factor (TNF) agents may further increase this risk.5 6 We conducted a retrospective cohort study of this question using the computerised data of Kaiser Permanente (KP; http://www.kaiserpermanente.org/). We defined a “severe RA cohort” of potential candidates for anti-TNF therapy as those aged 18 years and older from 1996–2002 who received at least two diagnoses of RA and were prescribed a disease-modifying antirheumatic drug (DMARD) after receiving methotrexate (n = 3982). Patients who had a previous history of anti-TNF agent were excluded. Follow-up began with the prescription of the first DMARD after methotrexate …
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