Onco-Rheumatology

Rheumatic diseases such as rheumatoid arthritis, lupus, scleroderma, or vasculitis are associated with an increased risk of cancer. At the same time, some cancer treatments can alter the immune system and cause inflammation and/or cause a new rheumatic condition to occur. 

Cancer treatments like chemotherapy, immunotherapy, radiation, and surgery can alter how your body functions. When inflammation occurs, it can damage joints and tendons or other internal organs. Managing inflammation is an important part of staying healthy and maintaining a good quality of life during and after cancer treatment.

Immunotherapy Side Effects
Immunotherapy uses your immune system to kill cancer cells. Some immunotherapy medications can aggravate an already-existing rheumatic disease or cause a new rheumatic disease, such as: 

• Rheumatoid arthritis
• Psoriatic arthritis
• Polymyalgia rheumatica
• Myositis
• Vasculitis

Cancer treatment impacts everyone differently. You may be referred to our experts because of a current condition or changes caused by your cancer treatment. 

Inflammatory Arthritis
Cancer treatments can cause inflammation in your joints that can result in joint pain, swelling, and limited mobility. You may struggle with severe stiffness in your joints or take much longer than usual to get moving in the morning. Occasionally your tendons may become inflamed and painful. If you have inflammatory joint symptoms prior to treatment, they can worsen during treatment.

Symptoms of inflammatory arthritis can mimic rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis. Your rheumatologist will check blood work and may take X-rays or use other imaging to evaluate your joints. They can offer treatments such as over-the-counter medications, prescription medications, or joint injections.

Polymyalgia Rheumatica (PMR)
Cancer treatments may also cause inflammation around the joints in bursae -- small, fluid-filled sacs -- and tendons. This can lead to severe stiffness or decreased mobility that might look like weakness. Your rheumatologist will evaluate your muscle strength. If your strength is normal but you have pain with specific movements of theshoulders and hips, you may have polymyalgia rheumatica. While there is no specific test for a PMR diagnosis, your rheumatologist can perform an exam and review your blood work to make a diagnosis. If PMR overlaps with inflammatory arthritis, your rheumatologist will treat both conditions. 

Osteoarthritis
Osteoarthritis occurs from “wear and tear” of the joints and is the most common cause of joint pain. Osteoarthritis is diagnosed through a physical exam, but imaging may be ordered for further evaluation. The condition can worsen during cancer treatments. Low-impact exercise and over-the-counter remedies are often the best way to alleviate stiff and painful joints. If you have severe symptoms in one joint, a joint injection may help. 

Myositis
Myositis is caused by inflammation in the muscles. Though it’s rare, cancer and cancer treatments can cause myositis, resulting in significant weakness in the affected muscle groups. Your rheumatologist will perform a physical exam to test your strength and take bloodwork to determine if you have muscle breakdown from inflammation. Prescription medications are available to treat myositis, some of which are infusions. 

Vasculitis
It is rare, but cancer and cancer treatments can cause vasculitis, or inflammation around blood vessels. Vasculitis is diagnosed using a combination of blood tests, imaging, and tissue biopsy. Your rheumatologist and oncologist will work together to create an individualized treatment plan for you. 

The long-term impacts of your cancer treatments vary greatly from person to person. Often, symptoms will only impact you for one to three years. However, the effects of medications may last much longer. Our rheumatologists will coordinate your care with your oncology team to manage any lasting impacts on your health.