| Cancer secondary to rheumatic disease |
|
| Chronic inflammation and damage from rheumatic disease |
Sjogren’s: disease activity, severity, duration predictive of non-Hogkin’s lymphoma risk RA: elevated ESR and CRP associated with increased cancer risk; longer duration corticosteroid therapy associated with lower lymphoma risk SSc: pulmonary scar associated with lung cancer |
| Cytotoxic or biologic therapies |
Cyclophosphamide: higher cumulative doses associated with increased risk of lymphoproliferative and bladder cancers Mycophenolate: Possible increase in non-melanoma skin cancer and CNS lymphoma TNF inhibitors: increased risk of non-melanoma and possibly melanoma skin cancer |
| Inability to clear oncogenic infections |
SLE: risk higher for virus-associated cancers (e.g. cervical, vaginal/vulvar, anal cancers associated with HPV) |
| Rheumatic disease secondary to cancer |
|
| Cancer-induced autoimmunity |
SSc: increased risk of cancer at disease onset among patients with RNA polymerase III autoantibodies; genetic abnormalities of POLR3A in cancers associated with mutation-specific T cell immune responses and cross-reactive autoantibodies Dermatomyositis: striking clustering of cancer diagnosis with disease onset; increased risk of CAM in patients with unique autoantibodies (NXP-2, TIF-1 gamma); clinical improvement in DM with cancer therapy |
| Immunotherapy or chemotherapy |
IL-2 therapy or immune checkpoint inhibitors: inflammatory arthritis and other autoimmune phenomena have been reported Bleomycin and gemcitabine: associated with skin sclerosis, development of exacerbation of Raynaud’s and ischemic digits |
| Radiation therapy |
Localized scleroderma may develop in radiation port |
| Shared etiology |
|
| Common inciting exposure |
Silica, solvents, organic chemicals, pesticides, smoking, infections, hormonal state |
| Shared genetic susceptibility |
Increased risks of Hodgkin’s lymphoma in patients with a personal or family history of multiple autoimmune conditions |
