The Link Between Rheumatoid Arthritis and Lymphoma
Having RA increases the risk of lymphoma. But for most, that risk appears quite small.
RA and the Risk of Lymphoma: Could It Be the Medications? continued...
However, many studies, including the Swedish study published in 2006, have shown no association between lymphoma risk and RA treatment, including treatment with methotrexate.
A newer class of medications raising concern is tumor necrosis factor (TNF) antagonists. These are also called anti-TNF drugs. This class of drugs includes Humira, Enbrel, and Remicade. They have been a lifesaver for patients with severe RA, like Burke. The Arthritis Foundation calls the medications an important addition to the disease's treatment arsenal.
To date, there has been no clear evidence that anti-TNF drugs lead to cancer in adults. A study published in May 2009 concluded that anti-TNF drugs did not further increase the risk of lymphoma in patients with RA. However, Putterman says, "The fact that we are not seeing it yet does not mean there is no link. It may simply mean we're not seeing it yet."
Nevertheless, as treatments become more potent, doctors worry about cancer and other side effects such as infection. Sweetenham is among those concerned: "I think there have been a lot of new drugs introduced into treatment in the last five to 10 years, and those drugs certainly have the potential to make the risk a little bit higher. The unknown is how much of a difference some of these newer drugs, such as the anti-TNF drugs, are going to make."
Doctors do agree, however, that the benefits of RA treatment far outweigh the potential risk of the medications. They encourage patients to sit down with their doctor and their family and weigh the pros and cons of treatments.
That's exactly what Burke did. After methotrexate failed, Burke's rheumatologist started her on anti-TNF therapy, first on Enbrel and now on Humira. The results have been amazing. Her RA is now completely under control. "The medicines gave me my life back," she says. "My medicine is my lifeline."
Doctors say there is no way to prevent lymphoma. Despite a few reports that oral steroids (such as prednisone) may reduce one's risk, the consensus among the doctors WebMD spoke with is that it's "very unlikely" that method would work.
Burke sees her doctor regularly to guard against any possible complications from the medications. Since her diagnosis, she's had a third child and organized a triathlon fundraiser for the local Arthritis Foundation. She even competed in the swim/run relay.
"I think a person with a chronic illness, especially one without a cure," she says, "has to be smart about how they are going to live their life so they can take advantage of all that life can offer."