Common Rheumatoid Arthritis Drug Won't Raise Blood Cancer Risk

(Page 2)

In the new study, the Montreal team looked at the medication use of almost 24,000 patients with rheumatoid arthritis to see if the connection might lie there. They compared rates of leukemia and lymphoma for this group for the years 1980 to 2003 against a much larger group of people unaffected by rheumatoid arthritis.

A total of 619 blood cancers (more than half of which were lymphomas) were noted among the rheumatoid arthritis patients over the study period.

Bernatsky's team found no association between the use of methotrexate and blood cancer risk, but the odds that a patient would develop a lymphoma more than doubled with use of cyclophosphamide.

Other experts agreed that the study's findings supported earlier research that had been reassuring about the impact of methotrexate. They also agreed on the need for patients and their doctors to weigh benefit and risk when considering cyclophosphamide.

Dr. Stephen Lindsey, chief of rheumatology at the Ochsner Clinic Foundation in Baton Rouge, La., said that the results on methotrexate seem "to be good news for the majority of rheumatoid arthritis patients, because they're almost all on that."

People need to recognize that rheumatoid arthritis is more than a few aching joints, he added. The disease can involve an increased risk of mortality -- in fact, patients with severe cases die an average of 10 years earlier than their peers, Lindsey said. And, he noted that rheumatoid arthritis has long been tied to an increased risk of lymphoma, separate from any risk associated with medication. Many lymphomas are curable, he said, another factor to think about when weighing the cyclophosphamide risk-benefit equation.

Dr. W. Hayes Wilson, a rheumatologist in Atlanta who is a national medical adviser for the Arthritis Foundation, added that the risks of cyclophosphamide have been recognized for years, although he personally could not recall any of his patients developing the blood cancer.

According to Wilson, cyclophosphamide is no one's first choice for treatment and is only used in the more severe cases. "You're sort of choosing between two evils," Wilson said. "No one wants to jump out of a perfectly good airplane, but if that airplane had two engines, and one was on fire, I might strap on that parachute and jump."