Prognostic significance of paraproteinaemia in rheumatoid arthritis

Article Abstract:

Several studies have suggested that patients with rheumatoid arthritis (RA) have a greater risk of developing myeloma (tumor of the portion of the bone marrow that synthesizes blood cells) or lymphoma (tumor of the lymphatic system, which makes lymphocytes, immune cells that fight against foreign or infected cells). The duration of RA is apparently important, but other risk factors linked with this association are unknown. One possible factor may be monoclonal gammopathy, an increased production of a single immunoglobulin (antibody) molecule by the immune system. This possibility was evaluated in a long-term study of 23 patients (14 female) with RA and paraproteinemia (abnormality in immunoglobulins in blood). Of the 23 patients, 21 had monoclonal and two had biclonal (two types of antibodies) gammopathy, with 13 having involvement of the immunoglobulin subtype IgG, while 8 had IgA and 4 had IgM. Paraprotein was found at the same time as or following diagnosis of RA in all cases. Eight patients excreted light chains (part of antibodies' structures) in urine. Twenty patients were had a positive blood test for IgM rheumatoid factor, an immunoglobulin that often indicates rheumatoid arthritis. Twelve patients had Sjogren's syndrome, which is also associated with an elevated risk of lymphoma. Thirteen patients had blood marrow abnormalities such as increased numbers of blood cells and or abnormal cell structures. Levels of IgA paraprotein rose significantly when checked at follow-up, from one to nine years later. Of 23 patients, five developed myeloma at follow-up (three of whom had IgA gammopathy), two had non-Hodgkin's lymphoma, and five of these seven were male. Three of five patients with myeloma had IgA paraprotein. Both patients with non-Hodgkin's lymphoma and two with myeloma had Sjogren's syndrome. Two patients with myeloma had urinary light chain excretion. RA duration was at least 12 years in patients who developed tumors, except for one who developed myeloma six years after diagnosis of RA. The study results suggest that the risk of lymphoproliferative tumors is greatest in RA patients with greater disease severity, those who are elderly males, and those with IgA paraprotein, especially where paraprotein levels rise significantly over a one-year period. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lymphoproliferative disorders, Immunoproliferative disorders, Multiple myeloma

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Rheumatoid arthritis, malignancy, and paraproteins

Article Abstract:

Rheumatoid arthritis (RA) is a joint disease characterized by inflammation, stiffness, swelling, and pain in the joints. Studies show that RA is associated with an increased incidence of lymphoma, a cancer of the lymphatic system, and myeloma, which is a tumor of the blood-forming cells in the bone marrow. In addition, RA patients have increased levels of paraproteins, which are abnormal blood proteins such as immunoglobulins (Ig). Gammopathy, an abnormal increase in these paraproteins, may be polyclonal, involving several types of Ig, or monoclonal, involving a single type of Ig. Monoclonal gammopathy has been associated with: myeloma, lymphoma, and other malignant growths; chest and liver infections; and connective tissue diseases in addition to RA. The incidence of monoclonal gammopathy is 1 to 2 percent in patients with RA as compared with less than 1 percent in the general population. Monoclonal gammopathy may be associated with later malignancy in patients with RA. Of 23 patients with RA, five developed myeloma, including three with IgA paraprotein. Another two patients developed non-Hodgkin's lymphoma and features of Sjogren's syndrome, a disease of the structural protein, collagen. Three of four patients with an immune disorder called immune paresis developed myeloma. None of the patients with polyclonal gammopathy developed malignancies. Studies show that patients with Sjogren's syndrome have an increased risk of lymphoma, and the blood levels of paraproteins served as a specific marker for later malignancy. In contrast, patients with systemic lupus erythematosus (SLE), an inflammatory disease of connective tissue, do not have an increased risk of lymphoma. IgA and certain drugs that suppress the immune system or kill cells have also been associated with the development of malignancy. Thus, patients with RA and monoclonal gammopathy should be routinely monitored for the development of malignancy, particularly if they are elderly or have increased levels of IgA paraprotein. (Consumer Summary produced by Reliance Medical Information, Inc.)

Immunoglobulins, Lymphomas

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Scleroderma and malignancy: an epidemiological study

Article Abstract:

Patients with scleroderma may have a higher risk of developing cancer than other individuals. Scleroderma is a connective tissue disorder characterized by hardening and thickening of the skin and degenerative changes in various body organs. A study compared the incidence of cancer among 233 scleroderma patients to that among the general population of the same geographic area between 1955 and 1984. The incidence of all types of cancers was significantly higher among the patients than the general population. Scleroderma patients also had a higher incidence of lung cancer and non-Hodgkin's lymphoma. A higher risk of non-Hodgkin's lymphoma has been found among patients with other connective tissue disorders such as rheumatoid arthritis.

Scleroderma (Disease)

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