The risk of leukemia in patients with rheumatoid arthritis: a systematic review and meta-analysis
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ORIGINAL ARTICLE
The risk of leukemia in patients with rheumatoid arthritis: a systematic review and meta-analysis Xiao Luo 1 & Yue He 2 & Wangdong Xu 3 & Mao Liu 1 & Zixia Zhao 1 & Lihui Peng 1 & Chengsong He 1 & Jie Chen 1 Received: 6 May 2020 / Revised: 18 August 2020 / Accepted: 12 September 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Objectives The relationship between rheumatoid arthritis (RA) and the risk of leukemia was still controversial. This study aimed to assess the risk of leukemia in patients with rheumatoid arthritis by systematic review and meta-analysis. Methods Relevant studies were identified by searching PubMed, Embase, Cochrane Library, and SinoMed up to December 2019. Random effects model analysis was used to pool standardized incidence ratios (SIRs) and 95% confidence interval. Results A total of 15 relevant studies that met the criteria were included. Compared with the general population, patients with RA showed an increased risk of leukemia (SIR = 1.51, 95% CI: 1.34–1.70). The statistical heterogeneity was moderate with an I2 of 55.5%. In subgroup analysis, the source of heterogeneity may be due to differences in sample size. Publication bias was not found in the Begg funnel plot and the Egger test. Conclusion Our findings suggested that the risk of leukemia in RA was increased compared with the general population. Key points • This is the first systematic review and meta-analysis to assess the risk of leukemia in RA. • Our study suggested that the risk of leukemia in RA was increased compared with the general population. • This study indicated that the risk of leukemia in RA was higher in non-Asian populations.
Keywords Leukemia . Meta-analysis . Rheumatoid arthritis . Risk
Introduction Rheumatoid arthritis (RA) is the most common chronic systemic inflammatory disease. Musculoskeletal pain, swelling, and stiffness are common symptoms of RA, which can lead to joint deformity and the loss of function, thereby, it can significantly reduce patients’ quality of life and long-term prognosis of RA [1]. RA is a multifactorial disease that may be closely related to genetic, environmental factors, and autoimmune * Jie Chen [email protected] 1
Department of Rheumatology and Immunology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
2
Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
3
Department of Evidence-Based Medicine, School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
responses [2]. The disease has also many complications, among which malignant tumors are one of the most difficult to control and life-threatening complications. The risk of cancer in patients with RA has received much attention. Many studies have investigated the relationship between RA and various cancers, and identified the relevant pathogenesis. The abnormal autoimmune mechanism may be a common cause of malignant tumors in RA [3]. In addition, related drugs for treating RA,
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