RA Lymphoma Risk — SCE Rheumatology MCQ
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Correct answer: E — RA confers roughly a twofold excess risk, greatest with persistently high cumulative inflammatory activity
Rheumatoid arthritis is associated with approximately twice the lymphoma incidence of the general population, with diffuse large B-cell lymphoma prominent among the excess cases. The strongest discriminator is cumulative inflammatory burden: patients with persistently severe, active RA have by far the greatest risk, supporting chronic immune stimulation as the principal driver. Methotrexate-associated lymphoproliferative disorders can occur and may regress after withdrawal, but methotrexate does not account for the overall population-level association. Similarly, UK registry data have not shown TNF inhibitors to increase lymphoma risk beyond the background risk associated with RA and its severity. Therefore A and B incorrectly attribute the excess primarily to treatment, while C and E incorrectly deny the independent association between RA and lymphoma.
Reference: Baecklund E et al. Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis & Rheumatism. 2006;54:692–701. https://pubmed.ncbi.nlm.nih.gov/16508929/