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Clinical aspects in patients with rheumatoid arthritis complicated with lymphoproliferative disorders without regression after methotrexate withdrawal and treatment for arthritis after regression of lymphoproliferative disorders
- Source :
- Modern Rheumatology. 31:94-100
- Publication Year :
- 2020
- Publisher :
- Oxford University Press (OUP), 2020.
-
Abstract
- To identify predictive factors for lymphoproliferative disorders (LPDs) that persist after methotrexate (MTX) withdrawal (Persistent-LPD) and the optimal treatment for rheumatoid arthritis (RA) after LPD regression.Among 3666 patients with RA treated with MTX in our department from 2006 to 2017, 26 cases of LPD that regressed after MTX withdrawal (Regressive-LPD) and 25 cases of Persistent-LPD were compared. Multivariate logistic analysis was performed to identify predictive factors for Persistent-LPD. Retention rates of biological disease-modifying antirheumatic drugs (bDMARDs) were calculated using the Kaplan-Meier Method.In Persistent-LPD, the incidence of diffuse large B-cell lymphoma was higher (76%). The overall 2-year survival rate was 83.9%: 95.8% for Regressive-LPD and 71.0% for Persistent-LPD. The International Prognostic Index (IPI) risk classification was useful for predicting Persistent-LPD. bDMARDs were introduced in 38 RA patients after LPD regression. Unadjusted retention rate of bDMARDs in the 51 LPD patients was significantly lower than that in the 1668 non-LPD RA patients in our bDMARD cohort (controls) (Risk assessment using IPI predicted Persistent-LPD. After LPD regression, non-TNFi tended to have higher retention rates.
- Subjects :
- Male
musculoskeletal diseases
medicine.medical_specialty
Arthritis
Lymphoproliferative disorders
Risk Assessment
Arthritis, Rheumatoid
03 medical and health sciences
0302 clinical medicine
Japan
Rheumatology
Recurrence
hemic and lymphatic diseases
Internal medicine
Humans
Medicine
In patient
Lymphocyte Count
Lymphocytes
030212 general & internal medicine
skin and connective tissue diseases
Aged
030203 arthritis & rheumatology
business.industry
Incidence
Optimal treatment
medicine.disease
Lymphoproliferative Disorders
Methotrexate
Withholding Treatment
Antirheumatic Agents
Rheumatoid arthritis
Female
business
medicine.drug
Subjects
Details
- ISSN :
- 14397609 and 14397595
- Volume :
- 31
- Database :
- OpenAIRE
- Journal :
- Modern Rheumatology
- Accession number :
- edsair.doi.dedup.....73348c47a351be3d541a6741f116f6e1