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Journal Articles RMD Open Year : 2021

Lymphoma complicating rheumatoid arthritis: results from a French case–control study

Joanna Kedra
Raphaele Seror
Philippe Dieudé
Arnaud Constantin
  • Function : Author
Eric Toussirot
Elias Kfoury
  • Function : Author
Charles Masson
  • Function : Author
Divi Cornec
Jean Jacques Dubost
Laurent Marguerie
  • Function : Author
Sebastien Ottaviani
  • Function : Author
Franck Grados
  • Function : Author
  • PersonId : 1151072
  • IdRef : 092785344
Rakiba Belkhir
  • Function : Author
Olivier Fain
Philippe Goupille
  • Function : Author
Christelle Sordet
  • Function : Author
Bruno Fautrel
Peggy Philippe
  • Function : Author
Muriel Piperno
  • Function : Author
Bernard Combe
  • Function : Author
Olivier Lambotte
  • Function : Author
Christophe Richez
Thomas Sené
Guillaume Denis
  • Function : Author
Thierry Lequerre
  • Function : Author
Thierry Lazure
  • Function : Author
Xavier Mariette
Gaetane Nocturne
  • Function : Author


Objectives To study the characteristics of B-cell non-Hodgkin’s lymphoma (NHL) or Hodgkin lymphoma complicating rheumatoid arthritis (RA) and to identify RA-related factors associated with their occurrence. Methods A multicentre case–control study was performed in France. Cases were patients with RA fulfilling ACR-EULAR 2010 criteria in whom B-cell NHL or Hodgkin lymphoma developed after the diagnosis of RA. For each case, 2 controls were assigned at random from the ESPOIR cohort and were matched on age at lymphoma diagnosis (cases)/age at the 10-year follow-up visit in the cohort (controls). Case and control characteristics were compared to identify parameters associated with the occurrence of lymphoma. Results 54 cases were included and matched to 108 controls. Lymphomas were mostly diffuse large B-cell lymphoma (DLBCL, n=27, 50.0%). On immunochemistry, 4 of 27 (14.8%) lymphoma cases were positive for Epstein-Barr virus. On univariate analysis, factors associated with the occurrence of lymphoma were male sex (OR 3.3, 95% CI 1.7 to 6.7), positivity for ACPA (OR 5.1, 95% CI 2.0 to 15.7) and rheumatoid factor (OR 3.9, 95% CI 1.6 to 12.2), and erosions on radiographs (OR 3.8, 95% CI 1.7 to 8.3) and DAS28 (OR 2.0, 95% CI 1.5 to 2.7), both at the time of matching. Methotrexate, TNF blockers and a number of previous biologics were not associated with the occurrence of lymphoma. On multivariable analysis, erosions and DAS28 remained significantly associated with increased risk of lymphoma. Conclusion Lymphomas complicating RA are mostly DLBCL. Risk of lymphoma in patients with RA was increased with markers of disease activity and severity, which supports the paradigm of a continuum between autoimmunity and lymphomagenesis in RA.

Dates and versions

hal-04001135 , version 1 (22-02-2023)



Joanna Kedra, Raphaele Seror, Philippe Dieudé, Arnaud Constantin, Eric Toussirot, et al.. Lymphoma complicating rheumatoid arthritis: results from a French case–control study. RMD Open, 2021, 7 (3), pp.e001698. ⟨10.1136/rmdopen-2021-001698⟩. ⟨hal-04001135⟩
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