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Rheumatoid arthritis
Original research
Trends of lymphoma incidence in US veterans with rheumatoid arthritis, 2002–2017
  1. Namrata Singh1,
  2. Yubo Gao2,3,
  3. Elizabeth Field2,4,
  4. Brian K Link5,
  5. Noel Weiss6,
  6. Jeffrey R Curtis7,
  7. Charles F Lynch8 and
  8. Mary Vaughan-Sarrazin3,4
  1. 1Rheumatology, University of Washington, Seattle, Washington, USA
  2. 2Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
  3. 3Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  4. 4Division of Immunology, Department of Internal Medicine, The University of Iowa, Iowa City, Iowa, USA
  5. 5University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
  6. 6Department of Epidemiology, University of Washington, Seattle, Washington, USA
  7. 7Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  8. 8Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
  1. Correspondence to Namrata Singh; nasingh{at}medicine.washington.edu

Abstract

Objective Past epidemiological studies have consistently demonstrated a link between rheumatoid arthritis (RA) and the incidence of lymphoma and it has been posited that high systemic inflammatory activity is a major risk determinant of lymphomagenesis. Given advances in the therapeutic armamentarium for RA management in recent years, the resulting lower level of disease activity could have led to a decline in lymphoma incidence in patients with RA. This study examined recent trends in lymphoma incidence in US veterans with RA.

Methods Patients with RA were identified in the Veterans Affairs (VA) Corporate Data Warehouse. Lymphoma incidence was identified through the end of 2018 from the VA Central Cancer Registry and compared among patients diagnosed during 2003–2005, 2006–2008, 2009–2011 and 2012–2014.

Results Among persons diagnosed with RA during 2003–2005, the incidence of lymphoma in the next 6 years was 2.0 per 1000 person-years. There was a steady decline in lymphoma incidence during the corresponding 6 years following diagnosis in the subsequent three cohorts, with a rate of 1.5 per 1000 person-years in the 2012–2014 cohort (incidence relative to that in the 2003–2005 cohort=0.79 (95% CI 0.58 to 1.1)). There was no similar decline in lymphoma incidence in VA patients diagnosed with osteoarthritis.

Conclusion We observed a decline in lymphoma incidence in recent years among American veterans with RA. Further studies are needed to evaluate the specific factors driving this decline.

  • Rheumatoid Arthritis
  • Epidemiology
  • Treatment
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/rmdopen-2020-001241

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    Footnotes

    • Contributors Concept, design and discussion of results and manuscript draft review: NS, CFL, EF, MV-S, NW and JRC. Cohort creation and data analysis: YG and MV-S.

    • Funding This work was funded by Grant IRG-15-176-41 from the American Cancer Society, administered through the Holden Comprehensive Cancer Center at The University of Iowa. Dr Vaughan Sarrazin receives support from the VA Health Services Research & Development Service.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Iowa City VA Medical Center.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article. Data availability is unfortunately not possible to protect patient confidentiality.