Sun exposure advice recommended for anti-TNF users

By Lynda Williams

Rheumatology patients using antitumor necrosis factor (TNF) treatment should be given sun exposure education to reduce their risk for skin cancer, say Irish researchers.

The team, from South Infirmary Victoria University Hospital in Cork, interviewed 150 inflammatory arthropathy patients using anti-TNF agents and found that just 5% had been given advice on the use of sunscreen or reducing sun exposure.

Of concern, 6% of patients had been diagnosed with skin cancer and a further 1% were awaiting results for a suspicious mole.

Patients using anti-TNF agents are estimated to have a 34% increased risk for nonmelanoma than those using nonbiologic disease-modifying antirheumatic drugs, with a higher risk found for joint treatment, explain Mortimer O'Connor and co-workers.

"This patient group needs to be educated regarding sun exposure, its risks, and prevention measures, along with the facts of skin cancer," they emphasize.

"It is questionable if patients should be assessed by a dermatologist before commencing anti-TNF therapy and should be followed up, at time intervals, after commencing anti-TNF therapy for skin cancers."

As reported in the Journal of Clinical Rheumatology, the patients had used anti-TNF drugs for an average of 3.64 years. The majority (73%) of patients questioned went on sunny holidays and 20% had used sunbeds, but just 65% reported using sunscreen, and 87% had experienced sunburn.

The researchers note that the patients with skin cancer were aged an average of 63 years, had used anti-TNF drugs for 4 years alongside nonbiologic drugs, and were diagnosed after treatment. None had ever received sun exposure advice.

While acknowledging that skin cancers were self-reported and no independent information was recorded on the type of skin cancers involved or any sun care advice given, the team concludes: "We await larger studies in this area of growing importance for rheumatologists using biologic therapies."

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