Malignancy and rheumatic diseases

Several systemic autoimmune rheumatic diseases carry an increased risk of malignancy compared to the general population, including dermatomyositis, Sjogren's disease (SjD), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc). This is likely a result of chronic inflammation, impaired tumor surveillance related to treatments, and shared risk factors, such as smoking. As treatments for systemic autoimmune rheumatic diseases continue to expand and cancer survival continues to improve, clinicians and patients are increasingly faced with complex decisions regarding the treatment of rheumatic autoimmune diseases in patients with current or prior malignancy. This review describes the risk of malignancy across the most common autoimmune diseases, highlights cancer screening recommendations in this patient population, and examines the evidence on the risk of de novo malignancy, or cancer progression and recurrence with the use of several biologic and targeted synthetic disease-modifying anti-rheumatic drugs. We also highlight important management considerations when selecting therapies to treat autoimmune diseases in patients with current or recent cancer.