PT  - JOURNAL ARTICLE
AU  - Yoshihiko Hoshida
AU  - Jing-Xian Xu
AU  - Shigeki Fujita
AU  - Itsuko Nakamichi
AU  - Jun-Ichiro Ikeda
AU  - Yasuhiko Tomita
AU  - Shin-Ichi Nakatsuka
AU  - Jun-Ichi Tamaru
AU  - Atsushi Iizuka
AU  - Tsutomu Takeuchi
AU  - Katsuyuki Aozasa
TI  - Lymphoproliferative disorders in rheumatoid arthritis: clinicopathological analysis of 76 cases in relation to methotrexate medication.
DP  - 2007 Feb 01
TA  - The Journal of Rheumatology
PG  - 322--331
VI  - 34
IP  - 2
4099  - http://www.jrheum.org/content/34/2/322.short
4100  - http://www.jrheum.org/content/34/2/322.full
SO  - J Rheumatol2007 Feb 01; 34
AB  - OBJECTIVE: Individuals with rheumatoid arthritis (RA) with or without methotrexate (MTX) medication occasionally develop lymphoproliferative disorders (MTX-LPD and non-MTX-LPD, respectively). The hyperimmune state of RA itself or the immunosuppressive state induced by MTX administration might contribute to development of LPD. Our objective was to characterize MTX-LPD in comparison to non-MTX-LPD and sporadic LPD in patients with RA. METHODS: We compared MTX-LPD to non-MTX-LPD and sporadic LPD by evaluating 48 cases of MTX-LPD, 28 non-MTX-LPD, and 150 sporadic LPD. RESULTS: Later onset age of LPD and female predominance were evident in patients with RA-LPD compared to sporadic LPD. The interval between the diagnosis of RA and LPD in MTX-LPD (median 132 mo) was significantly shorter than that in non-MTX-LPD (240 mo). The frequency of diffuse large B cell lymphoma (DLBCL) and positive rate of Epstein-Barr virus (EBV) in RA-LPD was significantly higher than in sporadic LPD (57.9% vs 42.7%, 27.6% vs 9.9%, respectively). After withdrawal of MTX, 11 of the MTX-LPD cases showed a spontaneous regression of tumors. The 5-year survival rate in RA-LPD (59.2%) was significantly worse than that in sporadic LPD (74.6%). CONCLUSION: The majority of cases of RA-LPD show similar clinicopathological characteristics irrespective of MTX medication, except for spontaneous regression of LPD after withdrawal of MTX in MTX-LPD, and a shorter interval between the diagnosis of RA and LPD in MTX-LPD than in non-MTX-LPD. RA-LPD cases showed younger age of onset, female predominance, unfavorable prognosis, and higher frequencies of DLBCL and EBV positivity compared to sporadic LPD.