Background Many reports suggest that inflammatory arthritides are associated with an increased prevalence of malignancies. The risk of developing malignancy seems to increase with arthritis severity and associated with the chronic systemic inflammation. Previously, we reported increased prevalence of malignancies in a cohort of patients with Psoriatic Arthritis (PsA). The most frequently observed lesions were cervical cancer and high grade dysplasia (7.14%; OR (95%CI)=6.4 (0.8-52.1), p=0.049). The prevalence of cervical dysplasia/cancer in that study was higher than the 10-year prevalence of cervicouterine cancer among females reported by the Canadian and Provincial Cancer Registries (7.1% vs. 3.0%, respectively). Only few reports looked at this form of malignancy in RA patients.
Objectives To investigate the overall prevalence of malignancy and particularly cervical dysplasia/cancer in patients with RA
Methods Patients were recruited prospectively from a rheumatology clinic and followed from January 2011 to December 2013. The prevalence of premalignant lesions/malignancy was evaluated and compared to the data provided by Statistics Canada, Canadian/Provincial Cancer Registries. Disease severity was assessed using CRP, ESR, DAS28, CDAI and SDAI scores. Paired t-test was used to compare disease parameters at baseline and 24 months. Pearson's Correlation, Regression and Multinomial Logistic Regression analyses were performed to examine association of malignancy with disease markers and treatment.
Results A cohort of 320 (76.3% females) RA patients was included in this study with mean (SD) age 54.8 (12.1) and mean (SD) duration of disease 10.7 (9.0) years. Overall, 52 (16.3%) precancerous lesions and cancers were analyzed; 51 patients (15.9%) had at least one premalignancy/cancer, one patient had a history of 2 cancers. The most frequently observed cancers were cervical (8.6% of female population; OR (95%CI) =3.96 (1.6-9.9); P=0.003), breast (3.3%; OR (95%CI) =1.33 (0.31-5.68); p=0.709), and bowel. 21 cases with cervical lesions were the focus of the investigation. Of them, 2 females had a history of cervical cancer (SCC), six-High Grade Squamous Intraepithelial lesion (HSIL). We were unable to track the exact type of cervical lesion in 13 remaining cases. All of them underwent hysterectomy prior to the study. Those women had moderate to high disease activity (DAS28-4.5 (1.0); CDAI-24.1 (9.1); SDAI-42.1 (33.3)) and moderate RA-related disability (HAQ-1.3 (0.6)). Analyses showed that the prevalence of cervical lesions was strongly correlated (r=0.188, p=0.003) with the number of swollen joints (OR (95%CI) =1.1 (1.0-1.1); p=0.041). It was also significantly correlated with the women's age at RA diagnosis (r=0.170, p=0.008), duration of disease (r=0.201, p=0.002), and treatment with NSAIDs (r=0.221, p<0.001). There was no association between cervical lesions and both smoking and previous treatment with MTX or biologics.
Conclusions Overall, there was an increased prevalence of malignancies among RA patients. The prevalence of cervical dysplasia/cancer in females with RA was higher than the tumor-based 10-year prevalence of cervicouterine cancer among females reported by the Canadian Cancer Registry-Statistics Canada and Provincial/Territory Cancer Registries (8.6% vs. 3.0%, respectively). Our findings suggest that special attention to the incidence of cervical lesions in females with RA should be considered.
Disclosure of Interest None declared