Arthropathies Associated With Cancer Immunotherapy

The immunotherapy of malignancy utilises the hosts immune system to destroy neoplastic cells. Polyarthritis may evolve or reappear as a result of this therapy. In a report of 3 patients receiving IL-2 immunotherapy for metastatic melanoma and renal-cell carcinoma, 2 patients developed a clinical picture resembling rheumatoid arthritis. A third patient, who had a remote history of Reiters syndrome, developed symmetric oligoarthritis [67]. The authors postulated induction of an autoimmune arthritis via an IL-2 induced T-cell mechanism, based on the inflammatory histologic findings, elevated levels of rheumatoid factor, positive antinuclear antibodies and positive HLA-DR4 genotype. Patients receiving IL-2 also developed spondiloarthritis with peripheral involvement and psoriatic arthritis [68]. The arthritis was self-limited, with improvement when immunotherapy was stopped but could be reproducibly induced by successive treatment cycles. HLA typing of these patients showed the presence of HLA-B27 and HLA-B38, both major histocompatibility complex antigens associated with the respective diseases. Three cases of self-limited symmetrical polyarthritis following tamoxifen therapy for breast cancer were described [69]. Arthritis was also seen in patients after interferon-a treatment. Pol yarthritis was the most common type of presentation, reported in 19 patients. Oligoarthritis or monoarthritis were less common, described in only 5 patients [70], Lately, there have been several reports on the development of symmetric polyarthritis in patients receiving Calmette-Guerin bacillus immunotherapy [71-73].

Patients with cancer undergoing immunotherapy may provide an excellent model for investigation and clarifying the mechanisms underlying inflammatory arthritides and autoimmunity in general [67],

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