Risk of Skin Cancer Increased in Rheumatoid Arthritis Patients

By Will Boggs, MD

NEW YORK NOV 21, 2005 (Reuters Health) - The risk of non-melanoma skin cancer is increased in rheumatoid arthritis patients, especially those that use prednisone and tumor necrosis factor (TNF) inhibitors, according to a report in the November issue of The Journal of Rheumatology.

"We hope that studies like these will not only help physicians and patients to be aware of possible risks so that they may institute appropriate surveillance measures, but will also begin to help us understand the biologic effects of systemic cytokine inhibition," Dr. Eliza F. Chakravarty from Stanford University School of Medicine, Palo Alto, California told Reuters Health.

Dr. Chakravarty and colleagues investigated the incidence of non-melanoma skin cancer (NMSC) in rheumatoid arthritis patients compared with osteoarthritis patients and sought to evaluate the role of several immunosuppressive medications in the development of NMSC.

After adjustment for known risk factors for the development of NMSC, patients with rheumatoid arthritis had a 19% higher risk of NMSC than did patients with osteoarthritis, the authors report.

In a multivariate model, the diagnosis of rheumatoid arthritis, increasing age, male gender, Caucasian ancestry, being married, and a history of NMSC were associated with an increased risk of NMSC.

Among patients with rheumatoid arthritis, the use of prednisone was associated with a 28% increased risk of NMSC, the researchers note, and the use of any TNF inhibitor was associated with a 24% increased risk (the latter did not reach statistical significance).

Rheumatoid arthritis patients using both methotrexate and any TNF inhibitor had a twofold risk of developing NMSC, the report indicates.

"To our knowledge, this is the first large cohort study of the associations between NMSC, rheumatoid arthritis, and immunosuppressive medications," the investigators write. "The increased hazard for the development of NMSC in patients with rheumatoid arthritis is in concert with that found in other studies of European populations."

"Currently, there are no clear recommendations for routine skin cancer screening in the general population," Dr. Chakravarty said. "If it is confirmed that rheumatoid arthritis itself and/or immunosuppressant medications do confer an increased risk, it may be prudent to recommend annual screening in these high-risk groups."

"The important thing will be to educate patients about this possible increased risk so that they are empowered to perform self-skin examinations, as well as being more attentive to protecting their skin from sun damage including regular use of sun screen and protective clothing," Dr. Chakravarty added.