Biological therapy and development of neoplastic disease in patients with juvenile rheumatic disease: A systematic review

Abstract

Juvenile rheumatic diseases affect the musculoskeletal system and begin before the age of18. These conditions have varied, identifiable or unknown etiologies, but those of an autoim-mune inflammatory nature have been associated with an increased risk of development ofcancer, regardless of treatment. This study aims to assess, through a systematic review of theliterature according to Prisma (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) quality criteria, the risk of cancer in patients with juvenile rheumatic disease, and its association with biological agents. The criteria described by the Strengthening theReporting of Observational Studies in Epidemiology initiative were used in order to assessthe methodological quality of those individual items selected in this study. We analyzednine publications, from a total of 251 papers initially selected. There was an increase in can-cer risk in the population with juvenile rheumatic disease versus the general population. Most specified cancers were of a lymphoproliferative nature. Seven studies did not spec-ify the treatment or not defined an association between treatment and cancer risk. Onlyone study has suggested this association; in it, their authors observed high risk in patientsdiagnosed in the last 20 years, a period of the advent of new therapies. One study foundan increased risk in a population not treated with biological agents, suggesting a disease inits natural course, and not an adverse effect of therapy. Studies have shown an increasedrisk of malignancy associated with juvenile rheumatic disease, and this may be related todisease activity and not specifically to the treatment with biological agents.