Analysis Of Clinical Characteristics And Risk Factors Of Rheumatoid Arthritis Complicated With Malignant Solid Tumor Liu Jiali

Background: Rheumatoid arthritis(RA)is one of the common connective tissue diseases in clinic.Chronic and invasive arthritis is the main clinical feature,and the global incidence of rheumatoid arthritis is gradually increasing.The occurrence of malignant tumor is one of the causes of death in patients with RA.Compared with the general population,the risk of RA complicated with malignant tumor is higher,and the risk of different types of malignant tumor is different.Objective: To study the clinical characteristics and risk factors of RA complicated with malignant solid tumor,and to understand the incidence and characteristics of patients with RA complicated with malignant solid tumor in this area,so as to provide clues and basis for the diagnosis and treatment of RA complicated with malignant solid tumor.Methods: According to the inclusion and exclusion criteria,54 patients with RA complicated with malignant solid tumor were selected from the patients hospitalized in Dalian city central hospital from January 2010 to December 2020,which were randomly selected as solid tumor group.108 patients with RA and no malignant tumor were randomly selected as non-tumor group.The basic clinical information,course characteristics,laboratory examination results,imaging examination results and treatment data of the two groups were collected.The statistical software SPSS 20.0 was used to process the data,and the difference was statistically significant.Results: There were 16 males and 38 females in solid tumor group with an average age of 64.89±9.23 years,while 29 males and 79 females in non-tumor group with an average age of 59.51 ±11.88 years.The age of tumor group was significantly higher than that of non-tumor group(P=0.004).In the solid tumor group,there were 20 cases of lung cancer(37.04%)and 15 cases of adenocarcinoma(27.78%).After the tumor types were classified by system,there were statistical differences in sex and age among some groups.There were more female patients in respiratory system tumor,thyroid cancer,reproductive system tumor and breast cancer group,and more male patients in digestive system tumor group.The age of onset in reproductive system tumor group was generally lower than that in respiratory system tumor,breast cancer and digestive system tumor group,and the onset age in thyroid cancer group was lower than that in digestive system tumor group.Malignant solid tumors occurred more frequently within10 years after RA diagnosis.The incidence of malignant solid tumors was the highest in the first 5 years of diagnosis,with a median course of 7.15 years.The time of morning stiffness in the non-tumor group was longer than that in the solid tumor group(P=0.003).The number of joint tenderness in tumor group was significantly more than that in non-tumor group(P=0.002),and extra-articular manifestations were more likely to occur in tumor group(P=0.033).The levels of aspartate aminotransferase(AST)and carcinoembryonic antigen(CEA)in tumor group were higher than those in non-tumor group(P=0.001),and the serum CEA level in tumor group was higher than that in non-tumor group(P=0.044).There were more negative anti-cyclic citrullinate peptide antibody(anti-CCP antibody)in tumor group than in non-tumor group(P=0.047).The level of tumor necrosis factor-α(TNF-α)in peripheral blood of tumor group was significantly higher than that of non-tumor group(P=0.017),while the percentage of natural killer cell(NK)was lower than that of non-tumor group(P=0.009),NK cell count was lower than that of non-tumor group(P=0.046).The tumor group was more likely to have enlarged lymph nodes(P=0.029)and larger pulmonary nodules(P=0.029).The comparison of X-ray staging of both knees between the two groups was statistically significant(P=0.039).There was significant difference in the time of occurrence of malignant solid tumor in RA patients under different treatment regimens(P=0.018).In the intra-group comparison,compared with the classic antirheumatic drug(DMARDs)combined with biological agents,the course of disease in the non-treatment group increased by 15.607 years(95%CI:0.87-30.34),and the difference was statistically significant(P=0.038).Conclusion: 1.Malignant solid tumors occurred more frequently within 10 years after RA diagnosis.The incidence of malignant solid tumors was the highest in the first 5years of diagnosis.With the passage of time,the incidence decreased gradually,and the median course of disease was 7.15 years.2.In RA with malignant solid tumors,lung cancer is the most common,and adenocarcinoma is the most known common pathological type.3.RA associated with respiratory system tumors,thyroid cancer,reproductive system tumors and breast cancer are more common in women,while digestive system tumors are more common in men.4.The average age of RA patients with digestive system tumors was the highest,followed by respiratory system tumors,breast cancer and thyroid cancer patients,and the youngest patients with reproductive system tumors.5.Compared with RA patients without malignant tumors,RA patients with malignant solid tumors had more joint tenderness and often accompanied with extra-articular symptoms.6.Most of the patients with RA complicated with malignant solid tumor have abnormal laboratory indexes and imaging examinations.when CEA,TNF-α increase,NK cell percentage and NK cell count decrease,positive anti-CCP antibody,lymph node enlargement and larger pulmonary nodules are abnormal,we should pay attention to regular tumor screening and follow-up to guard against the occurrence of malignant tumor.