Population-based cohort study on the risk of malignancy in East Asian children with Juvenile idiopathic arthritis

Victor C. Kok, Jorng Tzong Horng, Jing Long Huang, Kuo Wei Yeh, Jia Jing Gau, Cheng Wei Chang, Lai Zhen Zhuang

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32 Scopus citations


Background: To investigate the association and magnitude of risk between JIA, its associated treatment and cancer development in Taiwanese children. Methods: Nationwide population-based 1:4 age- and gender-matched retrospective cohort study was designed using the National Health Insurance Research Database of Taiwan. A cohort of 2,892 children <16 years old with JIA was formed as well as a non-JIA cohort of 11,568 in year 2003 to 2005. They were followed up till a diagnosis of malignancy or up to 8 years until 2010. Relative risk (RR), incidence rate ratio (IRR), and adjusted hazard ratio (aHR) of developing malignancy were calculated. Results: The female to male ratio was 0.79:1. There were 3 cases of incident cancer in the "MTX use, biologics-nai¨ve" group, only 1 in the anti-TNF biologics-containing group and 29 in the "both MTX- and biologics-nai¨ve" group, in comparison, there were 50 cases of cancer in the non-JIA comparator group. During a 16114.16 patient-years follow-up, the RR and IRR for developing a malignancy in both methotrexate- and anti-tumor necrosis factor (TNF) biologics-nai¨ve JIA children were 2.75 (95% confidence interval, 1.75 - 4.32) and 3.21 (2.01 - 5.05), respectively. For leukemia, the IRR was 7.38 (2.50 - 22.75); lymphoma, 8.30 (1.23 - 69.79); and soft tissue sarcoma, 11.07 (0.84 - 326.4). The IRR of other cancers was 2.08 (1.11 - 3.71). The aHR on cancer risk was 3.14 (1.98 - 4.98) in methotrexate- and biologics-nai¨ve group. There were no statistically significant increased risk in JIA patients treated with methotrexate and/or anti-TNF biologics. Conclusions: Compared with children without JIA, children with JIA have 3-fold increase of risk on malignancy in East Asia. Seemingly neither methotrexate nor anti-TNF biologics increases the risk further.

Original languageEnglish
Article number634
JournalBMC Cancer
Issue number1
StatePublished - 29 Aug 2014


  • Arthritis
  • Cohort studies (MeSH)
  • Juvenile idiopathic arthritis
  • Juvenile rheumatoid (MeSH)
  • Neoplasms (MeSH)
  • Risk (MeSH)


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