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Lymphoma complicating rheumatoid arthritis: results from a French casecontrol study

Joanna Kedra 1, 2 Raphaele Seror 2, 1 Philippe Dieudé 3 Arnaud Constantin 4 Eric Toussirot 5 Elias Kfoury 6 Charles Masson 7 Divi Cornec 8 Jean Dubost 9 Laurent Marguerie 10 Sebastien Ottaviani 3 Franck Grados 11 Rakiba Belkhir 2 Olivier Fain 12 Philippe Goupille 13 Christelle Sordet 14 Bruno Fautrel 15, 16 Peggy Philippe 17 Muriel Piperno 18 Bernard Combe 19 Olivier Lambotte 2 Christophe Richez 20 Jérémie Sellam 21, 12 Thomas Sené 22 Guillaume Denis 23 Thierry Lequerre 24, 25 Thierry Lazure 2 Xavier Mariette 2, 1 Gaetane Nocturne 2, 1
Abstract : Objectives To study the characteristics of B-cell non-Hodgkin’s lymphoma (NHL) or Hodgkin lymphoma complicating rheumatoid arthritis (RA) and to identify RA-related factors associated with their occurrence. Methods A multicentre case–control study was performed in France. Cases were patients with RA fulfilling ACR-EULAR 2010 criteria in whom B-cell NHL or Hodgkin lymphoma developed after the diagnosis of RA. For each case, 2 controls were assigned at random from the ESPOIR cohort and were matched on age at lymphoma diagnosis (cases)/age at the 10-year follow-up visit in the cohort (controls). Case and control characteristics were compared to identify parameters associated with the occurrence of lymphoma. Results 54 cases were included and matched to 108 controls. Lymphomas were mostly diffuse large B-cell lymphoma (DLBCL, n=27, 50.0%). On immunochemistry, 4 of 27 (14.8%) lymphoma cases were positive for Epstein-Barr virus. On univariate analysis, factors associated with the occurrence of lymphoma were male sex (OR 3.3, 95% CI 1.7 to 6.7), positivity for ACPA (OR 5.1, 95% CI 2.0 to 15.7) and rheumatoid factor (OR 3.9, 95% CI 1.6 to 12.2), and erosions on radiographs (OR 3.8, 95% CI 1.7 to 8.3) and DAS28 (OR 2.0, 95% CI 1.5 to 2.7), both at the time of matching. Methotrexate, TNF blockers and a number of previous biologics were not associated with the occurrence of lymphoma. On multivariable analysis, erosions and DAS28 remained significantly associated with increased risk of lymphoma. Conclusion Lymphomas complicating RA are mostly DLBCL. Risk of lymphoma in patients with RA was increased with markers of disease activity and severity, which supports the paradigm of a continuum between autoimmunity and lymphomagenesis in RA.
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Submitted on : Friday, September 24, 2021 - 4:47:36 PM
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Joanna Kedra, Raphaele Seror, Philippe Dieudé, Arnaud Constantin, Eric Toussirot, et al.. Lymphoma complicating rheumatoid arthritis: results from a French casecontrol study. RMD Open : Rheumatic & Musculoskeletal Diseases, EULAR ; BMJ, 2021, pp.e001698. ⟨10.1136/rmdopen-2021-001698⟩. ⟨hal-03354181⟩

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