Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
The Risk of Malignancy in a Large Cohort of Patients with Psoriatic Arthritis.
Gross1, Rachel L., Schwartzman-Morris1, Julie S., Krathen2, Michael, Reed3, George, Chang2, Hong, Saunders4, Katherine C., Fisher5, Mark C.
Albert Einstein College of Medicine, Bronx, NY
Tufts Medical Center, Boston, MA
University of Massachusetts, Worcester, MA
CORRONA, Inc., Southborough, MA
Massachusetts General Hospital, Boston, MA
Seattle Rheumatology Associate, Seattle, WA
There are few studies examining malignancy incidence in patients with Psoriatic Arthritis (PsA), and an increased malignancy risk in this population is often extrapolated from studies of patients with Rheumatoid Arthritis (RA) and Psoriasis. Knowledge of malignancy risk can help providers in counseling patients and aid in treatment decisions regarding the use of immunomodulatory medications. Therefore, we sought to determine the incidence rate and patient characteristics predictive of malignancy in a large observational cohort of patients with PsA, the CORRONA registry.
We included all patients with a diagnosis of PsA followed by CORRONA from 8/2003 to 8/2010. Patients with a previous history of malignancy and those with less than two CORRONA study visits for PsA were excluded. All cases of malignancy reported at CORRONA visits underwent an independent medical record review by two study investigators, and only confirmed cases were included in the analysis. Malignancy incidence rates with 95% confidence intervals were calculated. We then used Poisson regression models to determine patient specific variables predictive of first malignancy.
Of the 4428 patients enrolled in CORRONA, 2977 (mean age 51.2 ±12.5 years, 51.7% female) were eligible for our analysis, with 40 confirmed cases of malignancy during a total of 7156 patient-years of follow-up. The overall incidence rate (IR) of malignancy was 5.59 (95% CI 3.997.61) per 1000 patient years of follow-up, as compared to an IR of 5.44 (95% CI 4.566.32) in the RA CORRONA cohort1. The IR of lymphoma was 0.42 (95% CI 0.0861.23) and of non-melanoma skin cancer was 2.10 (95% CI 1.173.46), versus 0.70 (95% 0.391.02) and 1.89 (95% CI 1.372.41) respectively in the RA CORRONA cohort1. Incidence rates by cancer type are summarized in Table 1. In our Poisson regression model, both older age of onset of PsA (p<0.001, IRR=1.06, 95% CI 1.031.09) and longer disease duration (p<0.001, IRR=1.07, 95% CI=1.031.11) were predictive of first malignancy. CDAI and history of either methotrexate or anti-tumor necrosis factor use were not significant predictors.
Table 1. Incidence of Malignancy in CORRONA PsA Cohort
|Cancer type||Events||IR per 1000 patient years (95% CI's)|
|All cancers||40||5.59 (3.99, 7.61)|
|Non-Melanoma Skin Cancer (NMSC)||15||2.10 (1.17, 3.46)|
|All cancers excluding NMSC||25||3.49 (2.26, 5.16)|
|Solid||20||2.80 (1.71, 4.32)|
|Hematologic||5||0.70 (0.23, 1.63)|
|Breast||7||1.94 (0.78, 4.00)|
|Prostate||3||0.85 (0.18, 2.49)|
|Lymphoma||3||0.42 (0.086, 1.23)|
|Colorectal||3||0.42 (0.086, 1.23)|
|Melanoma||3||0.42 (0.086, 1.23)|
This is the first study to investigate malignancy incidence in a large U.S. cohort of patients with PsA. The incidence rate of malignancy in PsA patients appears similar to patients with Rheumatoid Arthritis in the CORRONA registry, and future analysis is planned to formally compare incidence rates between these two groups and with U.S. general population databases. Both older age of onset of PsA and longer disease duration were independent risk factors for development of malignancy in this Psoriatic Arthritis cohort.
To cite this abstract, please use the following information:
Gross, Rachel L., Schwartzman-Morris, Julie S., Krathen, Michael, Reed, George, Chang, Hong, Saunders, Katherine C., et al; The Risk of Malignancy in a Large Cohort of Patients with Psoriatic Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :509