PT  - JOURNAL ARTICLE
AU  - Sasha Bernatsky
AU  - Rosalind Ramsey-Goldman
AU  - Lawrence Joseph
AU  - Jean-Francois Boivin
AU  - Karen H Costenbader
AU  - Murray B Urowitz
AU  - Dafna D Gladman
AU  - Paul R Fortin
AU  - Ola Nived
AU  - Michelle A Petri
AU  - Soren Jacobsen
AU  - Susan Manzi
AU  - Ellen M Ginzler
AU  - David Isenberg
AU  - Anisur Rahman
AU  - Caroline Gordon
AU  - Guillermo Ruiz-Irastorza
AU  - Edward Yelin
AU  - Sang-Cheol Bae
AU  - Daniel J Wallace
AU  - Christine A Peschken
AU  - Mary Anne Dooley
AU  - Steven M Edworthy
AU  - Cynthia Aranow
AU  - Diane L Kamen
AU  - Juanita Romero-Diaz
AU  - Anca Askanase
AU  - Torsten Witte
AU  - Susan G Barr
AU  - Lindsey A Criswell
AU  - Gunnar K Sturfelt
AU  - Irene Blanco
AU  - Candace H Feldman
AU  - Lene Dreyer
AU  - Neha M Patel
AU  - Yvan St Pierre
AU  - Ann E Clarke
TI  - Lymphoma risk in systemic lupus: effects of disease activity versus treatment
AID  - 10.1136/annrheumdis-2012-202099
DP  - 2013 Jan 01
TA  - Annals of the Rheumatic Diseases
PG  - annrheumdis-2012-202099
4099  - http://ard.bmj.com/content/early/2013/01/08/annrheumdis-2012-202099.short
4100  - http://ard.bmj.com/content/early/2013/01/08/annrheumdis-2012-202099.full
AB  - Objective To examine disease activity versus treatment as lymphoma risk factors in systemic lupus erythematosus (SLE). Methods We performed case–cohort analyses within a multisite SLE cohort. Cancers were ascertained by regional registry linkages. Adjusted HRs for lymphoma were generated in regression models, for time-dependent exposures to immunomodulators (cyclophosphamide, azathioprine, methotrexate, mycophenolate, antimalarial drugs, glucocorticoids) demographics, calendar year, Sjogren's syndrome, SLE duration and disease activity. We used adjusted mean SLE Disease Activity Index scores (SLEDAI-2K) over time, and drugs were treated both categorically (ever/never) and as estimated cumulative doses. Results We studied 75 patients with lymphoma (72 non-Hodgkin, three Hodgkin) and 4961 cancer-free controls. Most lymphomas were of B-cell origin. As is seen in the general population, lymphoma risk in SLE was higher in male than female patients and increased with age. Lymphomas occurred a mean of 12.4 years (median 10.9) after SLE diagnosis. Unadjusted and adjusted analyses failed to show a clear association of disease activity with lymphoma risk. There was a suggestion of greater exposure to cyclophosphamide and to higher cumulative steroids in lymphoma cases than the cancer-free controls. Conclusions In this large SLE sample, there was a suggestion of higher lymphoma risk with exposure to cyclophosphamide and high cumulative steroids. Disease activity itself was not clearly associated with lymphoma risk. Further work will focus on genetic profiles that might interact with medication exposure to influence lymphoma risk in SLE.