Most of us are aware that there is a heightened risk for cancer if diagnosed with rheumatoid arthritis or other autoimmune diseases, because many of them “act” similarly at the cellular level. Additionally, certain medications may put RA patients at higher risk — but these same medications can ironically be used to treat cancer. “RA is not cancer – let’s be clear about that – but RA has some features that resemble cancer, so treatment we would normally think of as oncolytics have application to RA” says Gary S. Firestein, MD, chief of the Division of Rheumatology, Allergy and Immunology at the University of California, San Diego. “Kinship at the cellular level makes such treatment crossovers possible,” he says.
Sobering, but makes sense.
So, are kids with juvenile arthritis safe?
That depends on how you interpret the data of a new study.
Recently, the juvenile arthritis and rheumatology communities were faced with some serious news and statistics.
It was reported in a professional medical journal entitled, “Arthritis & Rheumatism” that the cancer rate among children with juvenile idiopathic arthritis (JIA, formerly known as JRA or Juvenile Rheumatoid Arthritis) is four times higher than in those without the disease. The study authors clearly state that this increase does not appear to be associated with medications including the use of tumor necrosis factor (TNF) inhibitors also known as biologics which have been a controversy in the past.
This new study is among the largest ever to examine cancers in children with juvenile arthritis.The researchers from the University of Alabama, Birmingham looked at Medicaid records from 2000 to 2005 and identified 7,812 children with JIA.
According to News-Medical.net, “Compared to children without JIA, children with the rheumatic disease had a 4.4-times greater cancer risk. Treatment with a TNF inhibitor did not appear to influence this risk. Study subjects with JIA had even higher rates of cancer, regardless of the treatments they received, than would be expected in the general population based on data.” The article goes on to state, “‘Chronic autoimmune inflammatory conditions such as JIA may be associated with an increased risk of malignancy irrespective of specific therapeutic agents. For example, an increased risk of lymphoma has been observed among adults with rheumatoid arthritis, particularly among those with a high burden of inflammatory activity,’ De. Beukelman and his colleagues noted. In an accompanying editorial, Drs. Karen and Kenan Onel of the University of Chicago urged caution in interpreting the study results. Although the UAB study does not fully exonerate TNF inhibitors, pediatric cancer specialist Kenan Onel, of the University of Chicago, calls the findings reassuring. ‘These drugs are very effective for the treatment of arthritis, so it is very reassuring to know that if they do carry a cancer risk it is probably very small,’ Onel says. ‘The not-so-reassuring news here is that just by having juvenile arthritis, a child may have an increased risk for cancer.’”
“Arthritis Today” echoes the sentiment that these findings carry both good and bad news with them, and that the results should be carefully interpreted. “A four-times greater cancer risk is higher than any previous reports, yet ‘cancer in children is very uncommon,’ Dr. Beukelman says. ‘The overall risk of cancer for children with JIA is still very low.’ He says it is possible that biologic agents will decrease the cancer risk caused by the disease through effectively decreasing inflammation that is present in JIA. ‘It’s important for families to realize that JIA itself can carry important risks too,’ says Dr. Beukelman. Barbara Adams, MD, chief of pediatric rheumatology at the University of Michigan at Ann Arbor, says she is not surprised about the increased cancer risk for children with JIA. ‘We see the same pattern in adults with RA,’ she notes. ‘As for many of the medications we use to control juvenile arthritis, I think they may actually reduce cancer risk because they control inflammatory damage from the disease,’ says Dr. Adams, echoing Dr. Beukelman. ‘These medications are much better at preventing disability and loss of function in children with arthritis, compared with the limited range of medications that we had before.’ As for the risks of medications to treat JIA, ‘Parents are caught between rock and hard place,’ says Dr. Adams, who is also on the medical advisory board for Arthritis Today. ‘If you want your child to be well, there are certain medications we need to use, even though there are small but definite risks involved. I try to be very clear about the risks involved in the medications I prescribe, but I also put those risks into context by explaining the risks of crippling arthritis, too.’In an editorial accompanying the study, Kenan Onel, MD, PhD, an associate professor of pediatrics and director of the Pediatric Familial Cancer Clinic at the University of Chicago, writes that Dr. Beukelman’s findings “are at once concerning and reassuring for physicians, parents and patients.”
- Ignoring juvenile arthritis is unacceptable — Juvenile arthritis is a major, serious, chronic disease for 300,000 children and teens, and requires national attention
- The fact that children with JIA have a cancer risk four times higher than those without the disease is unacceptable
- This study highlights the critical need of a national registry to collect data to track children with juvenile arthritis
- Congress and the National Institutes of Health/NIAMS needs to prioritize juvenile arthritis research funding
http://www.arthritis.org/ask/We all know that ignoring juvenile arthritis is unacceptable. Let’s be sure the President and Members of Congress hear our voice!”