Fast Five Quiz: Rheumatoid Arthritis Management

Herbert S. Diamond, MD; Abhishek Nandan, MD


February 22, 2023

Studies exploring the risk for malignancies associated with the use of TNF inhibitors point to a relationship between TNF inhibitor use and lymphomagenesis. Among older adults with RA, TNF inhibitor exposure was associated with elevated risk for non-melanoma skin cancer and non-Hodgkin lymphoma driven by follicular lymphoma. However, exposure was not associated with increased risk for other cancer sites.

The risk for malignancies has been shown to be increased with the JAK inhibitor tofacitinib vs TNF inhibitors, with the highest incidence among patients with an elevated risk for atherosclerotic cardiovascular disease (ASCVD). This trend is perhaps due to shared risk factors for cardiovascular risk and cancer. In a trial comparing combined tofacitinib doses with a TNF inhibitor in a cardiovascular risk–enriched population, risk for cancers and major adverse cardiovascular events was higher with tofacitinib and did not meet noninferiority criteria.

Learn more about side effects and risks associated with pharmacologic therapy for RA.


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