Clinical Characteristics of Methotrexate Associated Lymphoproliferative Disorders and RA Treatment After Lymphoproliferative Onset in 92 Cases

Tomohiro Kameda¹, Shusaku Nakashima¹, Masayuki Inoo², Ikuko Onishi², Noriyuki Kurata², Risa Wakiya³, Mai Mahmound Fahmy Mansour¹, Koichi Sugihara¹, Yusuke Ushio¹, Mikiya Kato¹, Hiromi Shimada¹ and Hiroaki Dobashi¹, ¹Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University., Kita-gun, Kagawa, Japan, ²Internal Medicine, Utazu hospital, Ayauta-gun, Kagawa, Japan, ³Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University., Kagawa, Kagawa, Japan

Meeting: ACR Convergence 2020

Keywords: rheumatoid arthritis

Session Information

Date: Monday, November 9, 2020

Title: Immunological Complications of Therapy Poster

Session Type: Poster Session D

Session Time: 9:00AM-11:00AM

Background/Purpose: Lymphoproliferative disorders (LPD) that develop in rheumatoid arthritis (RA) patients treated with MTX (MTX-LPD) is one of the important complications for RA patients. MTX-LPD has varied pathologies including various clinical manifestation and histological finding. Therefore, we need more information about MTX-LPD. In addition, it has not been established for RA treatment after the onset of MTX-LPD. We investigate the clinical characteristics of MTX-LPD and RA treatment after the onset of MTX-LPD.

Methods: We enrolled 92 MTX-LPD patients from Kagawa Prefecture, Japan between June 2005 and March 2020. Patients were diagnosed RA according to American College of Rheumatology (ACR) 1987 classification criteria or ACR/European League Against Rheumatism (EULAR) 2010 classification criteria, and treated with disease modifying antirheumatic drugs (DMARDs) including MTX. We collected as follow information; age, gender, duration of RA, laboratory data (LDH and sIL-2R) and treatment of MTX-LPD. We divided 92 MTX-LPD cases into spontaneous regression cases (SR group) and cases that treated with chemotherapy after MTX discontinuation (CTx group), and compared the difference between two groups. In addition, we investigated RA treatment after the onset of MTX-LPD.

Results: Characteristics of 92 MTX-LPD patients are as follow; mean age 66.2±10.9 years, 64 female, duration of RA 13.1±9.1 years. 62 patients (67.4%) were spontaneously improved by discontinuing MTX. The level of sIL-2R was significantly lower in SR group (p< 0.0001). Furthermore, the rate of extranodal lesion was more in SR group compared with CTx group (56.5% vs 41.4%). 73 patients (76.1%) were proven MTX-LPD histologically. In these patients, diffuse large B-cell lymphoma (DLBCL) was the most frequent histological diagnosis of MTX-LPD (38.0%). As regards RA treatment after MTX-LPD onset, conventional synthetic DMARDs alone, biologics or JAK inhibitors and NSAIDs or PSL alone treatment were 34, 20 and 10 cases respectively. The remaining cases were untreated, or unknown due to transferred to another hospital.

Conclusion: We indicated clinical characteristics of MTX-LPD with RA patients. In this study, we suggested that the serum sIL-2R level may predict SR of MTX-LPD. Additionally, biologics and JAK inhibitor have been used in many cases to control of RA activity after the onset of MTX-LPD. However, the association of JAK inhibitor and LPD onset is not clarify, and we need to accumulate the cases in the future.

Patients profile of MTX-LPD cases.

Disclosure: T. Kameda, None; S. Nakashima, None; M. Inoo, None; I. Onishi, None; N. Kurata, None; R. Wakiya, None; M. Fahmy Mansour, None; K. Sugihara, None; Y. Ushio, None; M. Kato, None; H. Shimada, None; H. Dobashi, None.

To cite this abstract in AMA style:

Kameda T, Nakashima S, Inoo M, Onishi I, Kurata N, Wakiya R, Fahmy Mansour M, Sugihara K, Ushio Y, Kato M, Shimada H, Dobashi H. Clinical Characteristics of Methotrexate Associated Lymphoproliferative Disorders and RA Treatment After Lymphoproliferative Onset in 92 Cases [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/clinical-characteristics-of-methotrexate-associated-lymphoproliferative-disorders-and-ra-treatment-after-lymphoproliferative-onset-in-92-cases/. Accessed .

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