Background/Purpose

Rheumatic diseases have been associated with an increased prevalence of malignancy. We aimed to examine the prevalence of precancerous lesions and malignancy in the entire cohort of patients with Inflammatory Arthritides; to compare the prevalence of malignancy between Rheumatoid (RA) and Psoriatic (PsA) Arthritis patients and to investigate correlations that may explain the high prevalence of cervical lesions that we noted.

 Methods

Patients were recruited prospectively from a rheumatology clinic specializing in treating patients with arthritis and followed from January 2011 to December 2013. The prevalence of premalignant lesions and malignancy was evaluated and compared to the data provided by Statistics Canada, Canadian and Provincial Cancer Registries. Disease severity was assessed using the TJC/SJC, CRP, ESR, DAS28, and CDAI scores.

Results

A cohort of 700 (67.9% females) patients with Inflammatory Arthritis was included in this study with mean (SD) age 55.0 (12.4) years and mean (SD) duration of disease 8.4 (8.3) years. Overall, 116 (16.6%) precancerous lesions and cancers were analysed. Hundred and ten patients (15.7%) had at least one malignancy; three patients had a history of 2 malignancies. The most frequently observed cancers were: Cervical (37-7.8% of female population; OR (95%CI)=2.5 (1.0-6.2); P=0.042), Breast (20-4.2% of female population; OR (95%CI)=1.1 (1.0-1.1); p=0.001), Bowel (11-1.6%), and Lung Cancer (10-1.4%).

We identified 37 cases with cervical lesions. Of them, six females had a history of cervical cancer (SCC), 18- High Grade Squamous Intraepithelial Lesions (HSIL), 8-Low Grade SIL cannot exclude HSIL, and in 5 cases it was impossible to trace the type of cervical dysplasia. Six cases belonged to women aged 49 years and younger, 31 cases of dysplasia and cancer belonged to women aged 50 years and older. All of them underwent hysterectomy prior to enrolment in the study. Prevalence of cervical lesions was strongly correlated with: females’ age (R=0.151, p=0.033), Health Assessment Questionnaire (HAQ: R=0.226, p=0.001) in PsA cohort; and with: females’ age at RA diagnosis (R=0.100, p=0.026), Tender Joint Count (TJC: R=0.108, p=0.016), and Clinical Disease Activity Index (CDAI: R=0.140, p=0.002) in RA cohort. Cervical lesions were strongly correlated with the total number of comorbidities in the both cohorts (PsA: R=0.161, p=0.023 & RA: R=0.088, p=0.049). The treatment of RA women with NSAIDs showed significant association with cervical lesions (r=0.123, p=0.006). No correlation with PASI score was detected in PsA patients. No definite association with treatment with biologic disease modifiers was documented.

Conclusion

 The prevalence of cervical dysplasia and cancer among affected women was higher than the tumor-based 10-year prevalence of cervicouterine cancer cases among females reported by the Canadian Cancer Registry, Statistics Canada and Provincial/ Territory Cancer Registries (7.8% vs. 3.0%, respectively). Our data suggested their possible correlation with disease activity. Closer surveillance will be warranted if the reported increased prevalence is confirmed in larger cohorts.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-prevalence-of-cervical-malignant-and-premalignant-lesions-among-women-with-rheumatoid-and-psoriatic-arthritis/