Background/Purpose: ,

Higher incidence of lymphoma in sjogrens syndrome has been reported since more than 5 decades now. Non Hodgkin’s Lymphoma (NHL) ranks as the seventh leading cause of cancer diagnosis in United States. There are numerous reports of Raynaud’s syndrome being an early paraneoplastic manifestation of occult malignancies.

Objectives:

To investigate the associations of  rheumatologic and immunologic conditions with NHL  in hospitalized patients with Sjogrens disease from a large nationwide hospital registry database.

Methods:

All hospitalized patients  included in the nationwide inpatient sample (NIS) 2010 database with a confirmed discharge diagnosis of Sjogrens disease, as per the ICD-9-CM code 710.2 were identified. NIS is the largest all-payer inpatient care database in the United States. Multivariable logistic regression models were used to determine the associations of rheumatic diseases and demographics of the population with Non-Hodgkin’s lymphoma among these patients. Discharge weight was used to measure national estimates.

Results:

From 7,800,441 hospitalizations in NIS 2010 database, 7,734 sjogrens syndrome patients were identified. Patients had a mean age of 63.47 (±16.03) years, 91.14% (7,049) were women. We used weighted analysis to estimate the national values. 38677 sjogrens syndrome patients were thus analyzed. 34923(90.29%)  had no NHL or Raynaud’s, 758 (1.96%) had no Raynaud’s but had NHL. 2843 (7.35%) had Raynaud’s present but no NHL. 153(0.4%) had both NHL and Raynaud’s. Models were adjusted for Age, Sex, Vasculitis, Systemic Lupus Erythematosus, HIV, Rheumatoid Arthritis, Dermatmyosisits, Polymyositis, Connective tissue disease, Polymyalgia Rheumatica, Systemic sclerosis, Celiac Disease, Hypthyroidism, Autoimmune hepatitis, Hepatitis C virus infection, Smoking history and African American race. African american race was independently associated with presence of NHL(adjusted odds ratio, 2.217; 95% confidence interval, 1.791 – 2.745 ; p<0.005)   Raynaud's syndrome was found to be independently associated with NHL (adjusted odds ratio, 2.854 ; 95% confidence interval, 2.357 – 3.456 ; p<0.005).(Table 1)

Conclusion:

In this large national database, African american race and Raynaud’s syndrome was independently associated with non-hodgkins lymphoma among hospitalized sjogrens patients. The presence of Raynaud’s syndrome  in patients with Sjogren’s should arouse  clinical suspicion for this feared complication.  Further prospective studies and are needed to understand this relationship in this high-risk population.

Table 1:

CHARACTERISTICS	Adjusted Odds Ratio	95% C.I.for OR		P Value
		Lower	Upper
AGE	1.010	1.006	1.015	.000
SEX(FEMALE)	1.330	1.080	1.638	.007
AFRICAN AMERICAN	2.217	1.791	2.745	.000
SLE	.716	.588	.873	.001
RHEUMATIOD ARTHRITIS	0.335	0.265	0.423	.000
RAYNAUD’S	2.854	2.357	3.456	.000
VASCULITIS	1.684	1.139	2.490	.009
POLYMYOSITIS	3.606	2.172	5.987	.000
CONNECTIVE TISSUE DISEASE	1.274	.671	2.418	.458
SYSTEMIC SCLEROSIS	0.866	0.618	1.214	.405
CELIAC DISEASE	2.203	1.313	3.695	.003
HYPOTYROIDISM	.753	.636	0.893	.001
AUTOIMMUNE HEPATITIS	0.999	.516	1.935	.997
HEPATITIS C VIRUS	1.402	.573	3.430	.459
SMOKING HISTORY	0.227	0.124	0.416	.000

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/raynauds-phenomenon-and-african-american-race-are-independently-associated-with-non-hodgkins-lymphoma-in-sjogrens-syndrome-patients-findings-from-a-united-states-national-study/