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Arthritis Care Res (Hoboken). 2019 Mar 1. doi: 10.1002/acr.23865. [Epub ahead of print]

Systematic Review of Recommendations on the Use of Disease-Modifying Antirheumatic Drugs in Patients with Rheumatoid Arthritis and Cancer.

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Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Division of Rheumatology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA.
Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.



To evaluate consensus recommendations regarding management of rheumatoid arthritis (RA) in patients with cancer.


We searched electronic databases, guideline registries, and relevant websites for cancer-specific recommendations on RA management. Reviewers independently selected and appraised the recommendations according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. We identified similarities and discrepancies among recommendations.


Of 4,077 unique citations, 39 recommendations were identified of which half described their consensus process. Average scores for the AGREE II domains ranged from 33% to 87%. Cancer risk in RA was addressed in 79% of recommendations, with acknowledgement of increased overall cancer risk. Recommendations did not agree on the safety of using disease-modifying antirheumatic drugs in RA patients with cancer, except for the contraindication of tumor necrosis factor inhibitors in patients at risk for lymphoma. Most recommendations agreed that RA treatment should be stopped and re-evaluated with a new diagnosis of cancer. Recommendations for patients with a history of cancer differed depending on the drug, cancer type, and time since cancer diagnosis. Few recommendations addressed all issues.


Recommendations for the treatment of RA in patients with cancer often fail to meet expected methodologic criteria. There was agreement on the need for caution when prescribing DMARDs to these patients. However, several areas remain lacking consensus and given the paucity of evidence, there is an urgent need for research and expert opinion to guide and standardize the management of RA in patients with cancer. This article is protected by copyright. All rights reserved.


biologic agents; cancer; clinical practice guideline; consensus statement; disease-modifying anti-rheumatic drugs; rheumatoid arthritis


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