1. POS0585 INCIDENCE AND CLINICAL CHARACTERISTICS OF MALIGNANCY IN RHEUMATOID ARTHRITIS PATIENTS – DATA FROM THE MALAYSIAN NATIONAL INFLAMMATORY ARTHRITIS REGISTRY (NIAR)
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S. Selvadurai, H. C. Chong, A. L. Lim, T. Chou Luan, S. A. Wan Mohamad Akbar, V. Y. Tay, C. Y. Lee, H. H. Ariff, D. M. Suahilai, C. R. Ng, N. Kiah Loon, A. H. Ramlan, G. R. Ling, R. Nasadurai, S. Ch’ng Suyin, S. Ahmad Maulana, M. Mohd Zain, and S. C. Gun
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Rheumatology ,Immunology ,Immunology and Allergy ,General Biochemistry, Genetics and Molecular Biology - Abstract
BackgroundPatients with rheumatoid arthritis (RA) are at increased risk of developing malignancies, particularly hematologic malignancies. This predisposition for malignancy is attributed to the immune dysregulation, chronic inflammation and the long-term use of disease-modifying anti-rheumatic drugs(DMARDs).ObjectivesThis study was undertaken to determine the incidence, patterns of malignancy and identify risk factors of malignancy among RA patients.MethodsIndividuals diagnosed with cancer after the onset of RA between year 2008 and 2020 from the NIAR RA registry were retrospectively examined. Standardized incidence ratios (SIR) and 95% confidence intervals of various cancers were calculated based on the expected and observed frequencies. The expected number of cases were extracted from the Malaysian National Cancer registry report. ANOVA, Chi-squared, and Student’s t test were used to analyze the risk factors for developing malignancy.ResultsOf the 3995 patients in the registry, 97 patients developed malignancies at a mean interval of 9.1 years after RA onset. The total follow-up time was 26841.9 person-years.The mean age of patients was 59.3 (± 9.25) years, of which 89.7%(n=87) were women and 40%(n=39) were Chinese.87.6%(n=84) had solid-organ tumours while 12.4%(n=13) had hematological malignancies.Women showed increased risks of non-Hodgkin’s lymphoma (SIR = 13.1, 95% CI = 9.78 – 17.08), followed by lung cancer (SIR = 12.7, 95% CI = 10.01-15.77) and breast cancer (SIR = 8.8, 95% CI = 7.84 – 9.83).Men showed increased risks of lung cancer (SIR = 3.79, 95% CI = 2.81 – 4.92) and colorectal cancer (SIR = 1.69, 95% CI = 1.09 – 2.42).The risk factors for developing malignancy (pThere were no associations between gender, ethnicity, autoantibodies and DMARDs exposure.ConclusionThe overall malignancy incidence was increased among RA patients, with women having a 4-fold higher risk. Though the incidence of solid-organ malignancies is higher, the SIR once adjusted was highest for non-Hodgkin’s lymphoma which is consistent with literature review. Hence, cancer screening with continued vigilance among RA patients is recommended.References[1]Hwajeong Lee. The risk of malignancy in Korean patients with rheumatoid arthritis. Yonsei Med J. 2019;60(2):223-229.[2]X.R. Lim, X. Gao, W.L.J. Tan, L.W. Koh, T.Y. Lian,W.Q. See, K.P. Leong, E.T. Koh•.Abstract: Singapore Patients with Rheumatoid Arthritis Have A Higher Incidence of Solid-Organ Malignancies than The General Population: Findings from The TTSH RA Registry.•bAnnals of the rheumatic diseases, BMJ Journals[3]Summary of Malaysia national cancer registry report 2012-2016, Institut Kanser Negara, Ministry of Health, MalaysiaTable 1.SIR of Malignancy among Rheumatoid Arthritis Patients by Sex and Age GroupsSex and Age GroupNumber of Patients (%)Person-YearsIncidenceSIR (95% CI*)ObservedExpectedSex (Age Group)Males10 (10.31%)48641.5 (0.54 - 2.94)Age at Diagnosis 50-604 (10.31%)12221 (0.09 - 2.87) 60-706 (60%)36422 (0.52 - 4.44)Females87 (89.69%)54059183.28 (2.49 - 4.17)Age at Diagnosis 30-5012 (13.79%)31751.4 (0.55 - 2.63) 50-6034 (39.08%)22824102.4 (1.54 - 3.46) 60-7041 (47.13%)2812839.33 (6.2 - 13.11)SIR, standardized incidence ratios; CI, confidence interval.Acknowledgements*CI = (√observed number of cancer cases ± 1.96 × 0.5)^2/(expected number of cancer cases).Disclosure of InterestsNone declared.
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- 2022