Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Psoriatic arthritis (PsA) is a systemic inflammatory disease that can have musculoskeletal (PsA-MsK) or concurrent MsK and skin (PsA-MsK/skin) manifestations, and the skin disease has the same clinical features as that of psoriasis (PsO). Such autoimmune diseases have been related to increased lymphoproliferative disease risk, which is thought to be due to continual exposure of systemic immunosuppressive therapies and abnormal immune activation. Such risk is well established in PsO, but is unclear in PsA. Also, the use of immunosuppressants has been a conflicting predictor in the development of malignancy. This study was undertaken to investigate the lymphoproliferative risk among patients with PsA-MsK/skin, PsA-MsK, and PsO and in relation to systemic immunosuppressive therapies, including tumor necrosis factor inhibitor (TNFi) and methotrexate (MTX).
A multicenter retrospective study involving four Veterans (VA) Hospitals in Southern California was performed (n=930,802). Patients with PsA-MsK/skin (n=18,339), PsA-MsK (n=9,437), and PsO (n=15,951) were assembled using the ICD 9 and 10 coding from 2000 to 2017. Each cohort member was linked to ICD-9 and ICD-10 codes for a diagnosis of lymphoma and leukemia. The Odds Ratio (OR) for developing any lymphoproliferative malignancy was calculated and the prevalence for individual lymphoma and leukemia subtypes were compared among the cohorts. A sample of patients with PsA-MsK/skin (n=42), PsA-MSK (n=57), and PsO (n=50) at Long Beach VA Hospital (VALB) and their use of TNFi and MTX therapy were analyzed in relation to their risk for developing malignancy, with the use of therapy defined as being ≥ 12 months of exposure.
In the PsA-MsK/skin, PsA-MsK, and PsO groups, the prevalence of lymphoma and leukemia was 0.25%, 0.66%, and 3.70%, respectively. The most common lymphoproliferative malignancy among all three groups was Non-Hodgkin’s lymphoma, with diffuse large B-cell lymphoma as the most prevalent subtype. Patients with PsA-MsK/skin have the lowest risk for developing lymphoproliferative cancer (OR 0.15), followed by those with PsA-MsK (OR 0.37) and PsO (OR 2.27; p<0.001 in all groups). In the VALB cohort, twice as many PsA-MsK/skin patients received combination TNFi and MTX therapy compared to PsA-MsK patients, and almost no PsO patients received systemic immunosuppressants (47.6%, 24.6%, 4.0%; p<0.001).
The subtypes of lymphoproliferative cancers were similarly distributed among patients with PsA and PsO. PsA patients have an unexpectedly low prevalence and low risk in developing lymphoproliferative cancers in comparison to PsO patients. One explanation is that aggressive management of PsA with systemic immunosuppression successfully controls autoimmune inflammatory processes and reduces the risk of developing malignancy. These findings also imply that, perhaps, biologics may not induce malignancy as suggested by other studies. Additional studies are needed to elucidate lymphoproliferative cancer risk in relation to disease activity and inflammatory markers in the future.
To cite this abstract in AMA style:Truong L, Wong M. Lymphoproliferative Malignancy in Psoriatic Arthritis and the Role of Systemic Immunosuppressive Therapies [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/lymphoproliferative-malignancy-in-psoriatic-arthritis-and-the-role-of-systemic-immunosuppressive-therapies/. Accessed January 24, 2020.
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