Rumatoid Arthritis caused by Chemo?

givingrace

Hi,

 Anyone end up with RA after chemotherapy. My past treatments have been two years of Rituxan, then 6 months of Treanda, Neulasta, and Rituxan, now I'm starting another 2 years of Rituxan. I have not been to primary yet but I am getting symptoms of RA in a few of my finger joints. So it hasn't been diagnosed yet but my retired from 30 years of medical PA medical friend thinks it is, a long with myself and a few other non certified know it all's (no harm just kinda joking) I am surrounded with a community of people who all have a little bit of medical in there backgrounds.  We are all speculating at this point. 

Any information on this topic? 

~GG~

 

 

Unknown

Not sure about chemo ...

as I have only had Rituxan. However my course of treatment was unusually intense (26 infusions). I definitely have more aches and pains than before the Rituxan. My hands hurt and my leg muscles cramp. I am ok otherwise. If you can tolerate it Celebrex really helps. I can't use Celebrex so I am stuck with time release Tylenol.

Also be careful with insect bites. I recently found a lone star tick on my hip after walking my dogs. Even with 200 mg/day of tetracycline the spot is like a raspberry in size and color and growing. The rituxan can make you more open to infections as much as 18-24 months after it is finished. Its been 14 months for me. My doc says its not unheard of out to 2 years. With ticks the key is to get them offf before they start burrowing. Fortunately this type of tick does not usually carry Lyme Disease but it does carry a couple of other very nasty bugs, one of which can make you allergic to red meat. Blackflies are bad too, and much more prevalent since hey are everywhere, not just in the grass.

good luck!

yesyes2

RA after chemo

Hi GG,  My name is Leslie.  I very rarely post anymore.  I am a little over 5 years out from RCHOP for an aggressive B cell lymphoma.  I also have suffered with RA for 24 years. In my opinion it is very unlikely that what you have is RA, which as you may already know is an autoimmune disease which can cause a lot more than swollen joints.  It is not unusual for people to experience joint pain after finishing chemo, but this pain usually resoves in time.  I don't know if there is a name for this conseqence.

My NHL was the result of taking immunosuppressing drugs for my RA.  Now the only medication I can take for inflammation, pain, and joint damage is Rituxan.  I have 2 doses 2 weeks apart every 6 months.  The dosage given is higher than what you get with chemo.  For me this is working, not as well as I would like, but it is working.

The most commen form of arthritis is osteo, are you sure that it isn't this form?  If the finger joint swelling is the first joints than it is osteo and not RA.  Also RA affects like joints on both sides of the body and joints are not just swollen but horribly painful, even when not moving. at least that has been my experience.  I hope that you don't have RA, as someone who has it would never want any one else to suffer from this disease.

Good luck and please let us know what happens.

Best,

Leslie

 

 

Max Former Hodgkins Stage 3

Shouldn't cause RA

GG,

One of the leading drugs employed in the US to treat RA is...Rituxan, so I would not think it could have caused RA .

http://www.rituxanforra.com/patient

 

max

littlemac

Have you had any hormonal therapy?

Hi.  My father has RA.  He was told it was an aftermath of his Radiation treatments after fighting Prostrate Cancer.  He was told that it was a direct result of the hormonal treatments he had to take in order to receive radiation.  I have heard of others having joint pain after being on Rituxan.  Have you had your doctor do bloodwork to test for RA?  I am hoping you do not have to deal with that.  Good Luck!

Scharfschutze15

Hello there,
my wife is

Hello there,

my wife is undergoing similar symptoms after chemo treatment for NHL. We recently were referred to a new immunologist/rheumatologist who deals with a lot of referrals from our oncologist specialitst at one of the best cancer hospitals in the US. He insists that a very large % of his patients who underwent some of the more severe forms of chemo (e.g. R-CHOP) see lots of RA-like symptoms, plus tingling, numbness, often severe pain in joints/muscles/bones that behaves without much pattern. He estimates that many people expect to recover from chemo too soon, especially if they're in remission where the mindset slowly moves into 'healing' mode. It can be 2 years before you start to pull out of if and another couple before you get back to 95-99% of where you were, however he also says 99% of people do recover back that far in time. The only thing he noted that is commonly a life-long side-effect is a certain numbness/tingling in the toes that often never goes away. The hands/fingers are often worst affected and take longer to recover. The chemo does a lot damage to your nerves and these take a long time to recover/regenerate.

I'd consider finding a good immunologist/rheumatologist to review this as they can rule out many forms of RA and other immune system issues. It doesn't make the symptoms much easier but living with something that should heal in time might be easier to bear.

Max Former Hodgkins Stage 3

Scharfschutze15 said:

Hello there,
my wife is

Hello there,

my wife is undergoing similar symptoms after chemo treatment for NHL. We recently were referred to a new immunologist/rheumatologist who deals with a lot of referrals from our oncologist specialitst at one of the best cancer hospitals in the US. He insists that a very large % of his patients who underwent some of the more severe forms of chemo (e.g. R-CHOP) see lots of RA-like symptoms, plus tingling, numbness, often severe pain in joints/muscles/bones that behaves without much pattern. He estimates that many people expect to recover from chemo too soon, especially if they're in remission where the mindset slowly moves into 'healing' mode. It can be 2 years before you start to pull out of if and another couple before you get back to 95-99% of where you were, however he also says 99% of people do recover back that far in time. The only thing he noted that is commonly a life-long side-effect is a certain numbness/tingling in the toes that often never goes away. The hands/fingers are often worst affected and take longer to recover. The chemo does a lot damage to your nerves and these take a long time to recover/regenerate.

I'd consider finding a good immunologist/rheumatologist to review this as they can rule out many forms of RA and other immune system issues. It doesn't make the symptoms much easier but living with something that should heal in time might be easier to bear.

Bamboozal

Scharf,

Ein paar fragen (a couple of questions):

Given that rituxan is given to treat RA by rheumatologists, in what sense could it CAUSE RA ?  The site linked does not list arthric symptoms as a common or uncommon side-effect of rituxan. But it does state that when joint-pain is noted, "A doctor should be consulted within 24 hours."  The problem with that (as I myself learned on r-abvd) is that, when receiving five drugs per cycle, how can one know which drug is causing which symptom ?  The only way to reasonably address that is knowing which drugs are linked in the literature to specific symptoms.

The numbness you mention in this and your other posts from 9/27 is most reasonably (that is, clinically) linked (when discussing r-chop patients) to the Vincristine.  Neuropathy, when it happens, varies dramatically from patient-to-patient. It is untreatable, except for symptom mitigation. Some people swear by various topicals, or diet-based approaches.  But, no FDA drug is currently approved to treat chemo-induced neuropathy (diabeted-induced neuropathy DOES have FDA approved drugs available, most of which are anti-depressant based meds).   I was in a nationwide clinical trial a fefw years ago for a proposed neuropathy treatment for chemo-induced forms. It was concluded to be a failure.  (Parts of what I wrote in this paragraph were derived from the literature provided by that study.)

My own neuropathy, induced by Vinblastine (a drug nearly identical to Vincristine in both operation and side-effects) was quite severe, and remains so, six years later.  Neuropathy usually subsides over time in severety, but some less so.  My extremeties remain numb most of the time, and keyboarding a message like this, or turning pages is an ordeal, quite frustrating and slow.  Nothng a specialist has in his bag of tricks can address it.

I am not sure from whence you derive your statement in regard to r-chop that is a "more severe form of chemo"?  It is of course the most common first-line treatment for NHL; most of the writers here have been on it. 

http://chemocare.com/chemotherapy/drug-info/vincristine.aspx

http://chemocare.com/chemotherapy/drug-info/Rituxan.aspx

 

max

Scharfschutze15

Max Former Hodgkins Stage 3 said:

Bamboozal

Scharf,

Ein paar fragen (a couple of questions):

Given that rituxan is given to treat RA by rheumatologists, in what sense could it CAUSE RA ?  The site linked does not list arthric symptoms as a common or uncommon side-effect of rituxan. But it does state that when joint-pain is noted, "A doctor should be consulted within 24 hours."  The problem with that (as I myself learned on r-abvd) is that, when receiving five drugs per cycle, how can one know which drug is causing which symptom ?  The only way to reasonably address that is knowing which drugs are linked in the literature to specific symptoms.

The numbness you mention in this and your other posts from 9/27 is most reasonably (that is, clinically) linked (when discussing r-chop patients) to the Vincristine.  Neuropathy, when it happens, varies dramatically from patient-to-patient. It is untreatable, except for symptom mitigation. Some people swear by various topicals, or diet-based approaches.  But, no FDA drug is currently approved to treat chemo-induced neuropathy (diabeted-induced neuropathy DOES have FDA approved drugs available, most of which are anti-depressant based meds).   I was in a nationwide clinical trial a fefw years ago for a proposed neuropathy treatment for chemo-induced forms. It was concluded to be a failure.  (Parts of what I wrote in this paragraph were derived from the literature provided by that study.)

My own neuropathy, induced by Vinblastine (a drug nearly identical to Vincristine in both operation and side-effects) was quite severe, and remains so, six years later.  Neuropathy usually subsides over time in severety, but some less so.  My extremeties remain numb most of the time, and keyboarding a message like this, or turning pages is an ordeal, quite frustrating and slow.  Nothng a specialist has in his bag of tricks can address it.

I am not sure from whence you derive your statement in regard to r-chop that is a "more severe form of chemo"?  It is of course the most common first-line treatment for NHL; most of the writers here have been on it. 

http://chemocare.com/chemotherapy/drug-info/vincristine.aspx

http://chemocare.com/chemotherapy/drug-info/Rituxan.aspx

 

max

Hi Max,
you're right on the

Hi Max,

you're right on the Rituxan point - I re-read the original post and see the question was wondering specficially about Rituxan as the culprit of the RA-like symptoms. I have no knowledge of that or Rituxan's specific impacts there and indeed, your reference to it being used to treat RA is well noted. I was speaking more generally on the longer-term impacts of chemotherapy in terms of residual symptoms that act a lot like RA. That vincristine is the likely culprit there is, as you note, documented. However, from our experience and conversations with both oncologists and immunologists, they note that a lot isn't known about the long term effects and how they can/will differ from one patient to the next.

Apologies if the rituxan mis-step was misleading. Main point was that chemo is acknowledged as causing long term damage that can act like RA (in part) but that it's also something that can and usually does improve/heal.

Much like your experiences, my wife continues to experience some severe but intermittent neuropathy and RA like symptoms. She would echo the typing/page turning struggles you mention. We went a long way through chemo before having any knowledge of this sort of thing.

On R-CHOP being among the harsher chemo regimens, that's based on comments from oncologists, immunologists chasing down the bad symptoms in the year since and talking to other people who've been through various different regimens for HL, NHL and Leukemia.

Max Former Hodgkins Stage 3

Scharfschutze15 said:

Hi Max,
you're right on the

Hi Max,

you're right on the Rituxan point - I re-read the original post and see the question was wondering specficially about Rituxan as the culprit of the RA-like symptoms. I have no knowledge of that or Rituxan's specific impacts there and indeed, your reference to it being used to treat RA is well noted. I was speaking more generally on the longer-term impacts of chemotherapy in terms of residual symptoms that act a lot like RA. That vincristine is the likely culprit there is, as you note, documented. However, from our experience and conversations with both oncologists and immunologists, they note that a lot isn't known about the long term effects and how they can/will differ from one patient to the next.

Apologies if the rituxan mis-step was misleading. Main point was that chemo is acknowledged as causing long term damage that can act like RA (in part) but that it's also something that can and usually does improve/heal.

Much like your experiences, my wife continues to experience some severe but intermittent neuropathy and RA like symptoms. She would echo the typing/page turning struggles you mention. We went a long way through chemo before having any knowledge of this sort of thing.

On R-CHOP being among the harsher chemo regimens, that's based on comments from oncologists, immunologists chasing down the bad symptoms in the year since and talking to other people who've been through various different regimens for HL, NHL and Leukemia.

Yes

SS,

Most cancers nowadays receive combination chemos; single-drug is rare, except in pallitative applications (stage 4 prostate cancer, for instance, will ordinarily receive just Taxotere, but it is never curative for PCa).  CHOP, ABVD, EPOCH, all are challanging.  How much so varies dramatically by patient. Some walk away with virtually no effects, others are laid out for a long time.  Besides my neuropathy, I lost all sense of taste, had continuous flu-like symptoms (muscle aches), my nails turned black (but did not fall out, which happens), tear ducts stayed inflammed, and more I can't even remember at this point -- perhaps from the chemo fog.   Hyperdose ICE and others regimens are commonly even worse, used in preparation for SCT.

Specifically regarding CHOP, the greatest long-term danger that is clinically established is the Adriamycin ('Rubix'), or "Red Devil."  It can cause thinckening of the heart muscle, which leads to weak blood ejection volume, which is essentially a drug-induced form of conjgestive heart failure.  The effects of this can be delayed for up to ten years.  Because ABVD also uses Adriamycin, I was tested for this last year, but was OK. The Cyclophosphamide causes infertility, sometimes temporarily, sometimes for life.   Prednisone, like any steroid, can cause catarac development.   ABVD also contains Bleomycin (not in CHOP), which in 10% of patiernts causes lung toxicity, and in 2% causes lung fibrosis. A good percentage of these die during treatment.  My breating got so weak during treatment that I could not walk to the car. At times I could not speak on a telephone.

Yes, they all are harsh. Side-effects are mostly not predictable, as are delayed, long term difficulties that may or may not ever arise.

I have always said that I would rather have side-effects than have cancer.  Consistent with this, I would rather have side-effects than be dead.

 

.

 

 

Unknown

unknown said:

Not sure about chemo ...

as I have only had Rituxan. However my course of treatment was unusually intense (26 infusions). I definitely have more aches and pains than before the Rituxan. My hands hurt and my leg muscles cramp. I am ok otherwise. If you can tolerate it Celebrex really helps. I can't use Celebrex so I am stuck with time release Tylenol.

Also be careful with insect bites. I recently found a lone star tick on my hip after walking my dogs. Even with 200 mg/day of tetracycline the spot is like a raspberry in size and color and growing. The rituxan can make you more open to infections as much as 18-24 months after it is finished. Its been 14 months for me. My doc says its not unheard of out to 2 years. With ticks the key is to get them offf before they start burrowing. Fortunately this type of tick does not usually carry Lyme Disease but it does carry a couple of other very nasty bugs, one of which can make you allergic to red meat. Blackflies are bad too, and much more prevalent since hey are everywhere, not just in the grass.

good luck!

Another thought

RA-like symptoms can exist without actually having RA. I definitely have RA-like symptoms but my blood RA factor is normal.Can't be sure if these symptoms are due to Rituxan or the lymphoma itself. However I really do think in my case its the Rituxan.

givingrace

Max Former Hodgkins Stage 3 said:

Yes

SS,

Most cancers nowadays receive combination chemos; single-drug is rare, except in pallitative applications (stage 4 prostate cancer, for instance, will ordinarily receive just Taxotere, but it is never curative for PCa).  CHOP, ABVD, EPOCH, all are challanging.  How much so varies dramatically by patient. Some walk away with virtually no effects, others are laid out for a long time.  Besides my neuropathy, I lost all sense of taste, had continuous flu-like symptoms (muscle aches), my nails turned black (but did not fall out, which happens), tear ducts stayed inflammed, and more I can't even remember at this point -- perhaps from the chemo fog.   Hyperdose ICE and others regimens are commonly even worse, used in preparation for SCT.

Specifically regarding CHOP, the greatest long-term danger that is clinically established is the Adriamycin ('Rubix'), or "Red Devil."  It can cause thinckening of the heart muscle, which leads to weak blood ejection volume, which is essentially a drug-induced form of conjgestive heart failure.  The effects of this can be delayed for up to ten years.  Because ABVD also uses Adriamycin, I was tested for this last year, but was OK. The Cyclophosphamide causes infertility, sometimes temporarily, sometimes for life.   Prednisone, like any steroid, can cause catarac development.   ABVD also contains Bleomycin (not in CHOP), which in 10% of patiernts causes lung toxicity, and in 2% causes lung fibrosis. A good percentage of these die during treatment.  My breating got so weak during treatment that I could not walk to the car. At times I could not speak on a telephone.

Yes, they all are harsh. Side-effects are mostly not predictable, as are delayed, long term difficulties that may or may not ever arise.

I have always said that I would rather have side-effects than have cancer.  Consistent with this, I would rather have side-effects than be dead.

 

.

 

 

Thanks everyone for the

Thanks everyone for the input.

I have been making some unexpected life changes and have been very busy making my world healthier and happier. No RV living yet but life is good today.

As for the possible RA problems , I am scheduled for xrays soon. I know why so long???....its a long story. LOL!

I did find out it is familial.My mom did have it and I also have a 1st cousin on my dads side who was doing "Gold" treatments in high school. When they did "Gold" treatments. I dont think they do them anymore. So, that being said the results will be interesting.

Its going to take me some time to catch up on everything but glad to see some familiar folks out there . 

 

GG

 

 

Mitou

Scharfschutze15 said:

Hello there,
my wife is

Hello there,

my wife is undergoing similar symptoms after chemo treatment for NHL. We recently were referred to a new immunologist/rheumatologist who deals with a lot of referrals from our oncologist specialitst at one of the best cancer hospitals in the US. He insists that a very large % of his patients who underwent some of the more severe forms of chemo (e.g. R-CHOP) see lots of RA-like symptoms, plus tingling, numbness, often severe pain in joints/muscles/bones that behaves without much pattern. He estimates that many people expect to recover from chemo too soon, especially if they're in remission where the mindset slowly moves into 'healing' mode. It can be 2 years before you start to pull out of if and another couple before you get back to 95-99% of where you were, however he also says 99% of people do recover back that far in time. The only thing he noted that is commonly a life-long side-effect is a certain numbness/tingling in the toes that often never goes away. The hands/fingers are often worst affected and take longer to recover. The chemo does a lot damage to your nerves and these take a long time to recover/regenerate.

I'd consider finding a good immunologist/rheumatologist to review this as they can rule out many forms of RA and other immune system issues. It doesn't make the symptoms much easier but living with something that should heal in time might be easier to bear.

R-CHOP and pain

I had 6 rounds of RCHOP in 2015 and in the spring of 2017, I started to get pain in my arms. Severe muscle ache, then bone ache, then shoulder joint ache. My 3 monthly check ups, (no scans) but blood work, is always fine. I have no B symptoms. I am fine apart from the aching shoulder joints and bone and muscle pain...( I was diagnosed in -15 with DLBCL stage IV. No radiotherapy, just chemo. )

I saw my oncologist last week and he seems surprised which doesn't make it any easier.  I am therefore grateful for Forums like this, where we can talk to other people who have undergone the same treatments and discuss our aches and pains.. 

I hope this will go away. I am happy to hear your oncologist talking about how many of his patients also was suffering from similar if not identical pains..

Mitou

Evarista

Mitou said:

R-CHOP and pain

I had 6 rounds of RCHOP in 2015 and in the spring of 2017, I started to get pain in my arms. Severe muscle ache, then bone ache, then shoulder joint ache. My 3 monthly check ups, (no scans) but blood work, is always fine. I have no B symptoms. I am fine apart from the aching shoulder joints and bone and muscle pain...( I was diagnosed in -15 with DLBCL stage IV. No radiotherapy, just chemo. )

I saw my oncologist last week and he seems surprised which doesn't make it any easier.  I am therefore grateful for Forums like this, where we can talk to other people who have undergone the same treatments and discuss our aches and pains.. 

I hope this will go away. I am happy to hear your oncologist talking about how many of his patients also was suffering from similar if not identical pains..

Mitou

Joint pain

Hi Mitou.  I very definitely got joint pain ~4 months after finishing R-EPOCH for DLBCL.  Severe bursitis in both shoulders, the second one less than a week after the first.  I hadn't been hang-gliding or anything remotely strenuous, so I and my oncologist concluded a systemic inflammatory episode or some kind.  Referral to Ortho confirmed bursitis (X-Ray & CT), so referral to Physical Therapy.  Still working on it 5 months later, but improving. Some low grade finger joint issues at the onset that have resolved on their own.  The shoulder inflammation did show up on my PET scans, so you might review the radiology notes if you have had one in the past year.  Good luck getting it sorted...physical therapy does help.