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Chronic Reactive Arthritis Secondary to Intravesical Bacillus Calmette–Guerin in Bladder Carcinoma

Derick N. Jenkins, MD, Josna Haritha, MD, & Huzaefah Syed, MD  |  Issue: September 2016  |  September 8, 2016

More consensus is needed regarding the proper treatment of the disorder in patients who do not improve with NSAIDs and/or glucocorticoids.

Key Message

Consider reactive arthritis secondary to BCG admin­istration in patients who present with arthralgias after receiving this treatment. The treatment options for chronic reactive arthritis secondary to BCG need to be further studied, particularly in patients who don’t improve with NSAIDs and/or glucocorticoids.

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Dr. Syed

Dr. Syed

Dr. Haritha

Dr. Haritha

Dr. Jenkins

Dr. Jenkins

Derick N. Jenkins, MD, completed medical school at Dartmouth in 2011 and finished an internal medicine residency at Virginia Commonwealth University (VCU) in 2016. He now serves as a chief medical resident.

Josna Haritha, MD, completed medical school at the University of Alabama at Birmingham in 2013 and finished an internal medicine residency at VCU in 2016. She now works as a hospitalist at McGuire VA Hospital.

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Huzaefah Syed, MD, joined the VCU faculty in 2012 as a rheumatology clinician–educator at the level of assistant professor. She completed all of her training at VCU School of Medicine and has a special interest in sarcoidosis and rheumatoid arthritis.

References

  1. Firestein GS, Budd RC, Harris ED, et al. Kelley’s Textbook of Rheumatology. 8th ed. Philadelphia: Elsevier Saunders, 2009; 1107, 1196.
  2. Bernini L, Manzini CU, Giuggioli D, et al. Reactive arthritis induced by intravesical BCG therapy for bladder cancer: Our clinical experience and systematic review of the literature. Autoimmun Rev. 2013 Oct;12(12):1150–1159.
  3. Neumayr C, Kirchgatterer A, Knoflach P. [Chronic reactive arthritis associated with Calmette-Guérin bacillus.] [article in German.] Dtsch Med Wochenschr. 2002 Sep 13;127(37):1886–1888.
  4. Lamm DL, Stodgill VD, Stodgill BJ, Crispen RG. Complications of bacillus Calmette-Guerin immunotherapy in 1278 patients with bladder cancer. J Urol. 1986 Feb;135(2):272–274.
  5. De Boer LC, Steerenberg PA, Van der Meijden PM, et al. Impaired immune response by isoniazid treatment during intravesical BCG administration in the guinea pig. J Urol. 1992 Nov;148(5):1577–1582.
  6. Tinazzi E, Ficarra V, Simeoni S, et al. Reactive arthritis following BCG immunotherapy for urinary bladder carcinoma: A systematic review. Rheumatol Int. 2006 Apr;26(6):481–488.
  7. van Eden W, Hogervorst EJ, van der Zee R, van Embden JD, et al. The mycobacterial 65 kD heat-shock protein and autoimmune arthritis. Rheumatol Int. 1989;9(3–5):187–191.

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