Remission of lymphoma after drug withdrawal in rheumatoid arthritis

RHEUMATOID ARTHRITIS is a common disorder. Its various articular and extra-articular manifestations are well described, but less well known is the association between rheumatoid arthritis and malignancy. There is an intrinsic risk of lymphoma, particularly non-Hodgkin’s lymphoma, in rheumatoid arthritis. In determining causality, it is difficult to separate the effects of treatment from those of the disease itself — most patients with rheumatoid arthritis are treated with more than one immunosuppressive agent during the course of their disease. Cyclosporin has been implicated in the development of lymphoma, predominantly in association with transplantation. 1,2 In addition, there are an increasing number of reports of B-cell lymphomas in rheumatoid arthritis patients that would seem to implicate methotrexate. 3-10 Clinical record A 63-year-old white man with seropositive rheumatoid arthritis presented to our outpatient clinic with a 4-week history of right hip and buttock discomfort. He described a deep ache, with no radiation. The pain was worse on weightbearing and during the night. He had had mild fevers, and had lost 7 kg in weight over the previous 2 months.