Background/Purpose: Rheumatoid arthritis (RA) is a systemic disease with a known association with lymphoma and interstitial lung disease (ILD). ILD is a frequent extraarticular manifestation of RA with a prevalence as low as 4% and as high as up to 68%. Additionally, patients with RA also have been documented to have an increased risk of lymphoma. It is unclear if the increased incidence of lymphoma or ILD is correlated to the disease itself or the treatment. In particular, new attention is being drawn to biologic agents being used to treat severe rheumatoid arthritis and whether these agents in particular, through immune-mediated actions, may specifically pose an increased risk of either ILD or lymphoma. This study aims to examine the incidence for ILD and malignancies in patients at the McGuire Veteran’s Medical Center with a diagnosis of RA as well as to examine the whether this incidence is affected by treatment.

Methods: Patients with an ICD-9 code of RA who have received care from a rheumatologist at the McGuire VA Medical Center are included in this study. Diagnosis of malignancy and ILD was determined by ICD-9 codes as well. As of now, 275 patients have met our inclusion criteria. Baseline demographic data, data regarding diagnosis and treatment of rheumatoid arthritis, and diagnosis of cancer and/or ILD were collected.

Results: Based on our current data, compared to the general population, the incidence of malignancy in our veteran population is 49% (p < 0.0001). This is higher than the general population. Patients with RA diagnosed at age 65 or above have a higher chance of being diagnosed with cancer (HR 1.089). The incidence of ILD is 9%; however, this is not significant compared to general population (p = 0.08). Interestingly, there appears to be a protective effect of treatment with a biologic in patients diagnosed with cancer (HR 0.54).

Conclusion: This is currently an ongoing study to examine the incidence of ILD/malignancy and correlation with biologic agents in the veteran population. The data collected shows an increased risk of malignancy. This appears to be rather notable when RA is diagnosed at an older age (>65). This could imply that later onset RA needs more aggressive treatment, and the potential protective effect of biologics on development of cancer imply that late onset RA may need more aggressive treatment with biologics. More studies need to be done to determine the significance of the protective effect of biologics. Our study is ongoing and sample size should be increased for more robust data. Additionally, study duration should be increased in order to follow younger patients that have been newly diagnosed with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-incidence-of-interstial-lung-disease-and-malignancies-in-veterans-with-rheumatoid-arthritis/