Post-chemotherapy arthralgia and arthritis in lung cancer

Abstract

Objective:Evaluate the characteristics of arthritis, arthralgia and musculoskeletal pain after chemotherapy in patients with lung cancer.Materials and Methods:In this study, we evaluate the characteristics of 17 patients with joint symptoms following receiving chemotherapy for lung cancer. Demographic information of patients including sex, age, time of rheumatologic findings after starting of chemotherapy, time of improvement after starting of medication, and relevant laboratory findings for each patient.Results:A total of seventeen patients (six women with mean age 41.2 ± 5.2 years and 11 men with mean age 42.5 ± 8.2) that received standard chemotherapy for lung cancer according to stage of disease. Joint symptoms usually began about seven months after the first session of chemotherapy. Patients had an average of two tender joints and 1 hr of morning stiffness. Four patients were positive for anti-nuclear antibody, and none of patient was positive for rheumatoid factor. Non-steroidal anti-inflammatory drugs, disease modifying anti-rheumatic drugs (DMARD), corticosteroids, and venlafaxine were prescribed. Four patients did not show an improvement. Follow-up was available for all patients. 11 patients showed favorable responses, characterized by a significant decrease (more than 50%) in morning stiffness, pain, and tender joint counts after a mean of three months’ treatment. Two patients had complete resolution of symptoms and did not required further medications for arthritis, arthralgia or musculoskeletal pain.Conclusion:Chemotherapy-related arthropathy in lung cancer is not uncommon. Early treatment with NSAID, DMARD, and corticosteroids is effective in the majority of patients.

Clinical characteristics and outcomes of cancer patients with post-chemotherapy arthritis: a retrospective case series report

“…Subsequent studies have also reported a short period of time (~3–8 months) before the onset of symptoms 6,8,9. However, the patients in our series presented with symptoms of arthralgia at widely varying time points after the initiation of chemotherapy.…”

“…Earlier studies5,6,8,9,11 have reported variable response rates to treatment with non-steroidal anti-inflammatory drugs or disease-modifying antirheumatic drugs. In our series, none of our patients were prescribed NSAIDs.…”

“…Loprinzi et al5 identified cyclophosphamide/fluorouracil adjuvant therapy as the most common regime associated with post-chemotherapy rheumatism. Standard adjuvant chemotherapy for patients with lung cancer and a combined regimen of cyclophosphamide and tamoxifen among breast cancer patients have been reported to be the most common regimens associated with the development of rheumatic symptoms 6,8. Another retrospective analysis that included a mixed group of cancer patients with posttreatment rheumatism found that fluorouracil was the most commonly prescribed drug, followed by cyclophosphamide and cisplatin 9.…”

“…Standard adjuvant chemotherapy for patients with lung cancer and a combined regimen of cyclophosphamide and tamoxifen among breast cancer patients have been reported to be the most common regimens associated with the development of rheumatic symptoms. 6 , 8 Another retrospective analysis that included a mixed group of cancer patients with posttreatment rheumatism found that fluorouracil was the most commonly prescribed drug, followed by cyclophosphamide and cisplatin. 9 However, in our series, there was no single agent or group of drugs more prominently associated with post-chemotherapy arthritis.…”

“…In 1993, Loprinzi et al first reported eight patients with breast cancer who developed post-chemotherapy rheumatism following a standard cyclophosphamide/fluorouracil therapeutic regimen 5. Subsequently, several studies have described the development of rheumatologic symptoms in different groups of patients, including those with lung cancer, ovarian cancer and Hodgkin’s lymphoma as well as patients with hematologic malignancies 6. Post-chemotherapy rheumatism may present as rheumatoid arthritis, reactive arthritis, vasculitis or arthritis, with the presence of rheumatoid factor (RF) and antinuclear antibodies (ANAs) 5…”