类风湿性关节炎（RA）是一种需要免疫抑制治疗的自身免疫性疾病。近几十年来，类风湿性关节炎的治疗取得了显著进展，尤其是生物学疾病修饰抗风湿药物（bDMARDs）和JAK抑制剂（JAKi）的发展。然而，新药物的开发伴随着新型治疗与恶性肿瘤风险之间的关联问题。本综述旨在讨论对RA、传统合成DMARDs、bDMARDs、JAKi及其与恶性肿瘤的关联的理解。此外，综述还讨论了接受b/tsDMARDs的患者的恶性肿瘤管理。虽然最近的研究表明，甲氨蝶呤和JAKi托法替尼有可能增加恶性肿瘤的潜在风险，但是避免对这些药物宽泛地停用治疗是至关重要的，因为这可能导致功能障碍和增加死亡率。因此，采用以个体患者特征为考虑因素的“目标治疗”（T2T）方法具有至关重要性。风湿病专科医师应对此情况保持警觉，认识到早期发现和管理的重要性。实施恶性肿瘤筛查计划是必不可少的，并且计算机断层扫描筛查的使用可能会增强管理策略的有效性。

Rheumatoid arthritis (RA) is an autoimmune disorder necessitating immunosuppressive therapy. Remarkable progress has been made in the treatment of RA over recent decades, particularly with the development of biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi). Nonetheless, the development of new drugs has been accompanied by concerns regarding the association between these novel therapies and the risk of malignancy.This narrative review aims to discuss the understanding of RA, conventional synthetic (cs) DMARDs, bDMARDs, JAKi, and their association with malignancy. Furthermore, the review discusses the management of malignancy in patients receiving b/tsDMARDs.Although recent studies suggest that the potential risk of malignancy of methotrexate and a JAKi tofacitinib, it is essential to avoid indiscriminate withholding of treatment by those agents, as this may lead functional impairment and increased mortality. Therefore, the adoption of a Treat-to-Target (T2T) approach considering individual patient characteristics, becomes of utmost importance. Rheumatologists should maintain a vigilant stance regarding malignancy in this context, recognizing the importance of early detection and management. Implementing a screening program for malignancies is indispensable, and the use of computed tomography screening may enhance the effectiveness of management strategies.