Cancer Drugs Raise Arthritis Risk – New Study

As if cancer patients don’t have enough to worry about, researchers have just found that case reports on 13 cancer patients suggest that “a small number of cancer patients taking the immunotherapy drugs ipilimumab and nivolumab may be at some higher-than-normal risk of developing autoimmune joint and tissue diseases, including inflammatory arthritis, ” according to the June 23, 2016 news release.

Study author Laura C. Cappelli, M.D. is a rheumatologist at the Johns Hopkins University School of Medicine. But the new study, however small in sample size, she says, is believed to be the largest published case series of a link between the drugs and the diseases.

“We keep having referrals coming in from our oncologists as more patients are treated with these drugs, ” said Clifton Bingham, M.D., associate professor of medicine at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Arthritis Center. “In particular, as more patients are treated with combinations of multiple immunotherapies, we expect the rate to go up.”

“In 2015, our rheumatology clinic started getting more and more referrals from our oncology department to evaluate patients treated with immunotherapies, ” says Cappelli. “And the patients we saw had very severe, highly inflammatory arthritis. They needed even higher doses of steroids to control their symptoms compared to what is needed in other forms of inflammatory arthritis, like rheumatoid arthritis.”

As indicated in the news release, “Overall, Cappelli and her colleagues identified 13 patients who had developed previously undiagnosed or reported rheumatologic symptoms after their treatment with the immune checkpoint inhibitors. All were over 18 and had been treated for melanoma, nonsmall-cell lung cancer, small-cell lung cancer or renal carcinoma. Eight were taking a combination therapy with both ipilimumab and nivolumab, while five were only taking one of the two drugs. Nine of the patients developed inflammatory arthritis, and the other four were diagnosed with sicca syndrome. With treatment, all patients were able to get their rheumatologic diseases under control, though not eliminated.”

Dr. Cappelli told OTW, “The arthritis induced by nivolumab and ipilimumab may affect only one or two joints at first, so patients may be referred to orthopedic surgery clinic. If there are signs that a patient has an inflammatory arthritis after treatment with these drugs, orthopedic surgeons should involve rheumatology in the evaluation of the patient.”