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

Figures & data

Table 1 Characteristics of seven cancer patients with post-chemotherapy arthritis from different centers in Saudi Arabia from 1993 to 2015

Case	Age (years)	Sex	Cancer type	Treatment/chemotherapy regimen	Time to onset of rheumatic symptoms	Lab results	Clinical presentation	Treatment of rheumatic symptoms	Patient adherence	Recovery/prognosis
Case 1	79	Male	Multiple myeloma	Melphalan, dexamethasone and allopurinol	3 months post initiation of chemotherapy	ANA, RF, ACPA and CRP wnl	Pain in all joints, including knees, MCP, wrists and shoulders	Folic acid, MTX, prednisone and alendronate	Non-adherent	Initial pain relief in the first 2 years/persistent knee pain requiring wheelchair and pain in hands
Case 2	70	Female	Breast cancer	Mastectomy/six cycles of cyclophosphamide MTX Fluorouracil/radiotherapy Tamoxifen for 5 years Lumpectomy/DCH/radiotherapy	6 years post initiation of chemotherapy	CRP, ACPA wnl and slightly elevated RF	Pain in right ankle, MCP and PIP joints	MTX	Discontinued	Symptoms not resolved and no improvement noted
Case 3	45	Female	Breast cancer	Adjutant chemotherapy (no details available)/radiotherapy Tamoxifen for 5 years	7 years post initiation of chemotherapy was diagnosed with fibromyalgia 12 years post initiation of chemotherapy was diagnosed with arthritis	Slightly elevated ESR. CRP, RF and ACPA wnl	Body aches, pain and numbness in right thigh Swelling and tenderness in wrist Effusion in MCP and PIP joints	MTX HCQ	Adherent	Mild improvement in symptoms at 6 months follow-up
Case 4	60	Female	Adenocarcinoma of sigmoid colon	Colectomy/eight cycles of capecitabine and oxaliplatin, XELOX	1 year post initiation of chemotherapy	RF, ACPA and CRP wnl	Stiffness and pain in MCP and PIP joints	MTX	Adherent	80% improvement at 1 year
Case 5	31	Female	Adenocarcinoma of colon	Hemicolectomy/six cycles of adjuvant capecitabine	4 months post initiation of chemotherapy was diagnosed with arthritis 12 months post initiation of chemotherapy was diagnosed with fibromyalgia	Slightly elevated CRP and RF	Bilateral MCP joints, knees, hips and right shoulder	MTX	Adherent	Mild improvement in symptoms at 12 months follow-up, after which the diagnosis of fibromyalgia was made
Case 6	53	Female	Breast cancer	Mastectomy/nine cycles of chemotherapy (was received in another center, no details available)	5 months post initiation of chemotherapy	Elevated RF, ACPA, ESR and mildly elevated CRP	Back pain and pain in multiple joints	Sulfasalazine	Adherent	No resolution of symptoms but stable. In subsequent follow-up, she started to show good response. However, she passed away after developing bony metastasis
Case 7	60	Female	Ovarian cancer	Paclitaxel	5 years from first chemotherapy	Elevated ESR. RF, ACPA, CRP wnl and slightly decreased vitamin D	Morning stiffness, pain and swelling in MCP and PIP joints	MTX	Adherent	Significant improvement in symptoms with resolution of joint tenderness

Abbreviations: ANA, antinuclear antibody; RF, rheumatoid factor; ACPA, anti-cyclic citrullinated peptide antibody; CRP, C-reactive protein; wnl, within normal limits; MCP, metacarpophalangeal; MTX, methotrexate; DCH, docetaxel, cyclophosphamide, trastuzumab; PIP, proximal interphalangeal; ESR, erythrocyte sedimentation rate; HCQ, hydroxychloroquine.