Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Rheumatology International
Published in: Rheumatology International 6/2006

01-04-2006 | Review Article

Reactive arthritis following BCG immunotherapy for urinary bladder carcinoma: a systematic review

Authors: Elisa Tinazzi, Vincenzo Ficarra, Sara Simeoni, Walter Artibani, Claudio Lunardi

Published in: Rheumatology International | Issue 6/2006

Login to get access

Abstract

Intravesical instillation of Bacillus Calmette-Guerin (BCG) is used with efficacy and safety in the treatment of patients with intermediate and high-risk superficial bladder carcinoma. Arthralgia and/or arthritis is one of the rare severe complications following intravesical BCG immunotherapy. We searched MEDLINE in order to analyze the frequency of this clinical complication, its pathogenesis and outcome. The electronic search was conducted using the following key words: “BCG immunotherapy” and “Arthritis, arthralgias and BCG immunotherapy”. At the end of a process of abstract analysis, 48 papers were included in the systematic review. All the selected papers, except one that was a clinical review, described at least one case of arthritis after BCG therapy. The BCG immunotherapy resulted to be safe and efficacious in the treatment of bladder cancer; the development of reactive arthritis is rare and can evolve in a chronic process. The review of the literature highlighted that reactive arthritis following BCG intravesical instillation is a complication usually well controlled with the discontinuation of the immunotherapy and nonsteroidal anti-inflammatory drugs (NSAIDs) treatment. Only a small portion of patients with a particular genetic background will develop a chronic process.
Literature
1.
Jemal A, Tiwari RC, Murray T et al (2004) Cancer statistics 2004. Cancer J Clin 54:8–29PubMed
2.
Messing EM, Catalona W (1998) Urothelial tumors of the urinary tract. Campbell’s urology, 7th edn. WB Saunders Co, Philadelphia
3.
Dalbaghi G, Herr HW (2000) Current use and questions concerning intravesical bladder cancer group for superficial bladder cancer. Urol Clin North Am 27:137–146CrossRefPubMed
4.
Herr HW (2000) Tumor progression and survival of patients with high grade, noninvasive papillary (TaG3) bladder tumors: 15-year out-come. J Urol 163:60–62CrossRefPubMed
5.
Herr HW, Schwalb DM, Zhang ZF et al (1995) Intravesical bacillus Calmette-Guerin therapy prevents tumor progression and death from superficial bladder cancer: ten-year follow-up of a prospective randomized trial. J Clin Oncol 13:1404–1416PubMed
6.
Nseyo UO, Lamm DL (1996) Therapy of the superficial bladder cancer. Semin Oncol 23:598–604PubMed
7.
Cheng CW, Chan SFP, Chan LW, Chan CK, Ng CF, Cheung HY et al (2004) 15-year experience on intravesical therapy of T1G3 urinary bladder cancer: a conservative approach. Jpn J Clin Oncol 34 (4):202–205CrossRefPubMed
8.
Morales A, Nickel JG (1976) Immunotherapy of superficial bladder cancer with BCG. World J Urol 3:209–214CrossRef
9.
Lamm DL (2000) Efficacy and safety of bacille Calmette-Guerin immunotherapy in superficial bladder cancer. Clin Infect Dis 31 (Suppl 3):S86–S90CrossRefPubMed
10.
Talic RF, Hargreave TB, Bishop MC, Kirk D, Prescott S (1994) Intravesical Evans bacille Calmette-Guerin for carcinoma in situ of the urinary bladder. Scottish Urological Oncology Group. Br J Urol 73:645–648PubMedCrossRef
11.
Morales A, Ottenhof P, Emerson L (1981) Treatment of residual non infiltrating bladder cancer with Bacillus Calmette-Guerin. J Urol 125:649–651PubMed
12.
Lamm DL, Blumenstein BA, Crawford ED et al (1991) A randomized trial of intravesical doxorubicin and immunotherapy with Bacillus Calmette-Guerin for transitional cell carcinoma of the bladder. N Engl J Med 325:1205–1209PubMedCrossRef
13.
Hurle R, Losa A, Manzetti A, Lembo A (1999) Intravesical bacille Calmette-Guerin in stage T1 grade 3 bladder cancer therapy: a 7 year follow-up. Urology 54:258–263CrossRefPubMed
14.
Herr HW, Pinsky CM, Whitemore WF, Sogani PC, Oettgen HF, Melamed MR (1986) Long term effect of intravesical bacillus Calmette-Guerin on flat carcinoma in situ of the bladder. J Urol 135:265–267PubMed
15.
Herr HW, Sogani PC (2001) Does early cystectomy improve the survival of patients with high risk superficial bladder tumors? J Urol 166:1296–1299CrossRefPubMed
16.
Satoh A, Hanawa Y, Nakamura S (2004) Clinical study of bladder cancer: proteinuria as a predictor of recurrence and efficacy of intravesical bacille Calmette-Guerin therapy. Int J Urol 11:476–482CrossRefPubMed
17.
Lamm DL, Van der Meijden ADPM, Morales A et al (1992) Incidence and treatment of Bacillus Calmette Guerain intravesical therapy in superficial bladder cancer. J Urol 147:596–600PubMed
18.
Tinazzi E, Ficarra V, Simeoni S, Peterlana D, Lunardi C (2005) Reactive arthritis following BCG immunotherapy for bladder cancer. Clin Rheumatol 24:425–427CrossRefPubMed
19.
Lamm DL, Stodgill VD, Stodgill BJ, Crispen RG (1986) Complications of bacillus Calmette-Guerin immunotherapy in 1278 patients with bladder cancer. J Urol 135:272–274PubMed
20.
Hughes RA, Allard SA, Maini RN (1989) Arthritis associated with adjuvant mycobacterial treatment for carcinoma of the bladder. Ann Rheum Dis 48:432–434PubMed
21.
Ochsenkuhn T, Weber MM, Caselmann WH (1990) Arthritis after Mycobacterium bovis immunotherapy for bladder cancer. Ann Int Med 112:882PubMed
22.
al Khalifa MA, Elfving P, Mansson W, Colleen S (1991) Bacillus Calmette-Guerin treatment of 39 patients with superficial transitional cell carcinoma of the bladder. Scand J Urol Nephrol 25:135–139PubMedCrossRef
23.
Kudo S, Tsushima N, Sawadaa Y, Saito F, Motomura F, Takashima T, Kogawa T, Suzuki T, Kurotaki H, Masumori J et al (1991) Serious complications of intravesical bacillus Calmette-Guerin therapy in patients with bladder cancer. Nippon Hinyokika Gakkai Zosshi 82:1594–1602
24.
Chapman PT, Mark SD, Moller PW (1992) Arthritis associated with adjuvant mycobacterial treatment for carcinoma of the bladder. N Z Med J 105:37–38PubMed
25.
Van Thiel RJ, Nossent GD, Tjon Pian Gi NP (1992) Articular complications of intravesical BCG treatment for bladder carcinoma. Br J Urol 70:446–447PubMed
26.
Goupille P, Soutif D, Valat JP (1992) Arthritis after Calmette-Guerin bacillus immunotherapy for bladder cancer. J Rheumatol 19:1825–1826PubMed
27.
Chazerain P, Desplaces N, Ziza JM, Pierrot S, Cordonnier C, Chanzy M (1992) BCG osteoarthritis on knee prosthesis after intra-vesical BCG therapy. Rev Rhum Mal Osteoartic 59:836–838PubMed
28.
Belmatoug N, Levy-Djebbour S, Appelboom T et al (1993) Polyarthritis in 4 patients treated with intravesical BCG-therapy for carcinoma of the bladder. Rev Rhum Ed Fr 60:162–166PubMed
29.
Faus S, Martinez Montauti JM, Puig L (1993) Reiter’s syndrome after administration of intravesical bacille Calmette-Guerin. Clin Infect Dis 17:526–527PubMed
30.
Xerri B, Chretien Y, Le Parc JM (1993) Reactive polyarthritis induced by intravesical BCG therapy for carcinoma of the bladder. Eur J Med 2:503–505PubMed
31.
Jawad AS, Kahan L, Copland RF, Henderson DC, Abdul-Ahad AK (1993) Reactive arthritis associated with bacillus Calmette-Guerin immunotherapy for carcinoma of the bladder: a report of two cases. Br J Rheumatol 32:1018–1020PubMedCrossRef
32.
Pancaldi P, Van Linthoudt D, Alberino D, Haefliger JMM, Ott H (1993) Reiter’s syndrome after intravesical bacillus Calmette-Guerin treatment for superficial bladder carcinoma. Br J Rheumatol 32:1096–1098PubMedCrossRef
33.
Price GE (1994) Arthritis and iritis after BCG therapy for bladder cancer. J Rheumatol 21:564–565PubMed
34.
Goupille P, Poet JL, Jattiot F, Mattei JP, Vedere V, Tonolli-Serabian J et al (1994) Three cases of arthritis after BCG therapy for bladder cancer. Clin Exp Rheumatol 12:195–197PubMed
35.
Varoqua S, Lin-Greenberg A, Brown M (1994) Polyarthritis in an elderly man with bladder cancer. Hosp Pract 29:75–78
36.
Devlin M, Deodhar A, Davis M (1994) Arthritis as a complication of intravesical BCG vaccine. Br Med J 308:1638
37.
Thepot C, Martigny J, Simon L, Bellin J, Larget-Piet B, Chevalier X (1995) Acute polyarthritis after BCG-therapy for bladder carcinoma in a patient with ankylosing spondylitis. Rev Rhum Engl Ed 62:459–461PubMed
38.
Queiro R, Ballina J, Weruaga A, Fernandez JA, Rientra JL, Torre JC, Rodriguez A (1995) Psoriatic arthropathy after BCG immunotherapy for bladder cancer. Br J Rheumatol 34:1097PubMedCrossRef
39.
Hammadeh MY, Dutta SN, Worraall JG, Morgan RJ (1995) Acute reactive polyarthritis after intravesical bacillus Calmette-Guerin instillation. Br J Urol 76:811–812PubMed
40.
Goupille P, Valat JP (1996) Arthritis after bacillus Calmette-Guerin therapy. J Rheumatol 23:1481–1482PubMed
41.
Miossec P (1996) Reactive arthritis associated with bacillus Calmette-Guerin immunotherapy for carcinoma of the bladder: immune reactivity against mycobacterial antigens. J Rheumatol 23:1485PubMed
42.
Rodevand E, Faxvaag A, Ostensen M, Brevik B (1996) Arthritis after BCG treatment of bladder cancer. A rare complication. Tidsskr Nor Laegeforen 116:3231–3232PubMed
43.
Smith MD, Chandran G, Parker, Youssef PP, Ahern M, Coleman MA et al (1997) Synovial membrane cytokine profiles in reactive arthritis secondary to intravesical bacillus Calmette-Guerin therapy. J Rheumatol 24:752–758PubMed
44.
Saporta L, Gumus E, Karadag H, Kuran B, Miroglu C (1997) Reiter syndrome following intracavitary BCG administration. Scand J Urol Nephrol 31:211–212PubMedCrossRef
45.
Farahat MN (1997) Selective migration of the human helper/inducer T-cell subset (CD4+) in BCG-induced arthritis. Biochem Soc Trans 25:371SPubMed
46.
Hansen CP, Mortensen S (1997) Epididimo-orchitis and Reiter’s disease. Two infrequent complications after intravesical bacillus Calmette-Guerin therapy. Scand J Urol Nephrol 31:317–318PubMedCrossRef
47.
48.
Fond L, Bencharif L, Guglielminotti C, Lauwers A, Lucht F (1998) Acute oligo-arthritis in a patient treated with BCG therapy for bladder carcinoma. Presse Med 27:475PubMed
49.
Milas L, Maillefert JF, Michel F, Piroth C, Wautot A, Tavernier C (1999) Refractory arthropathy after intravesical bacillus Calmette-Guerin therapy. Usefulness of isoniazide. Rev Rhum Engl Ed 66:106–108PubMed
50.
Clavel G, Grados F, Cayrolle G, Bellony R, Leduc I, Lafont B, Ducroix JP, Fardellone P (1999) Polyarthritis following intravesical BCG immunotherapy. Report of a case and review of 26 cases in the literature. Rev Rhum Engl Ed 66:115–118PubMed
51.
Onur O, Celiker R (1999) Polyarthritis as a complication of intravesical bacillus Calmette-Guerin immunotherapy for bladder cancer. Clin Rheumatol 18:74–76CrossRefPubMed
52.
Schwartzenberg JM, Smith DD, Lindsley HB (1999) Bacillus Calmette-Guerin associated arthropathy mimicking undifferentiated spondyloarthropathy. J Rheumatol 26:933–935PubMed
53.
Chevrel G, Zech C, Miossec P (1999) Severe uveitis followed by reactive arthritis after bacillus Calmette-Guerin therapy. J Rheumatol 26:1011PubMed
54.
Varentsov GI, Zakhmatov IuM, Kornev AI, Otvetchikov IN (1999) Polyarthritis as a rare complication in BCG immunoprophylaxis of urinary bladder cancer. Urologia 5:29–30
55.
Aharon-Maor A, Shoenfeld Y (2000) The good, the bad and the ugly of vaccination. Isr Med Assoc J 2:225–227PubMed
56.
Hodish I, Ezra D, Gur H, Strego R, Olchovsky D (2000) Reiter’s syndrome after intravesical bacillus Calmette-Guerin therapy for bladder cancer. Isr Med Assoc J 2:240–241PubMed
57.
Hogarth MB, Thomas S, Seifert MH, Tariq SM (2000) Reiter’s syndrome following intravesical BCG therapy. Postgrad Med J 76:791–793CrossRefPubMed
58.
Mouly S, Berenbaum F, Kaplan G (2001) Remitting seronegative symmetrical synovitis with pitting edema following intravesical bacillus Calmette-Guerin instillation. J Rheumatol 28:1699–1701PubMed
59.
Shoenfeld Y, Aron-Maor A, Tanai A, Ehrenfeld M (2001) BCG and autoimmunity: another two-edged sword. J Autoimmun 16:235–240CrossRefPubMed
60.
Neumayr C, Kirchgatterer A, Knoflach P (2002) Chronic reactive arthritis associated with Calmette-Guerin bacillus. Dtsch Med Wochenschr 127:1886–1888CrossRefPubMed
61.
Pardalidis NP, Papatsoris AG, Kosmaoglou EV, Georganas C (2002) Two cases of acute polyarthritis secondary to intravesical BCG adjuvant therapy for superficial bladder cancer. Clin Rheumatol 21:536–537CrossRefPubMed
62.
Bartolome Pacheco MJ, Martinez-Taboada VM, Blanco R, Rodriguez-Valverde V, Valle JI, Lopez-Hoyos M (2002) Reactive arthritis after BCG immunotherapy: T cell analysis in peripheral blood and synovial fluid. Rheumatology 41: 1119–1125CrossRefPubMed
63.
Mas AJ, Romera M, Valverde-Garcia JM (2002) Articular manifestations after the administration of intravesical BCG. Joint Bone Spine 69:92–93CrossRefPubMed
64.
Pego JM, Lamas C, Hernandez I, Suso J (2003) Relapsing Reiter’s syndrome after bacillus Calmette-Guerin immunotherapy for bladder carcinoma. Med Clin 121:356–357CrossRef
65.
Shiba M, Fujii T, Takatera H (2003) Reiter syndrome after intravesical bacillus Calmette-Guerin (BCG) immunotherapy: a case report. Hinyokika Kiyo 49:599–601PubMed
66.
Narvaez J, Castro-Bohorquez FJ, Vilaseca-Momplet J (2003) Sjogren’s-like syndrome following intravesical bacillus Calmette-Guerin immunotherapy. Am J Med 115:418–419CrossRefPubMed
67.
Lam JS, Benson MC, O’Donnell MA, Sawczuk A, Gavazzi A, Wechsler MH et al (2003) Bacillus Calmette-Guerin plus interferon-α2B intravesical therapy maintains an extended treatment plan for superficial bladder cancer with minimal toxicity. Urol Oncol 21:354–360PubMed
68.
Prescott S, James K, Hargreave TB, Chisholm GD, Smyth JF (1992) Intravesical Evans strain BCG therapy: quantitative immunohistochemical analysis of the immune response within the bladder wall. J Urol 147:1636–1642PubMed
69.
Jackson AM, Alexandroff AB, Kelly RW, Skibinska A, Esuvaranathan K, Prescott S et al (1995) Changes in urinary cytokines and solubile intercellular adhesion molecule-1 (ICAM-1) in bladder cancer patients after bacillus Calmette-Guerin (BCG) immunotherapy. Clin Exp Immunol 99:369–375PubMedCrossRef
70.
Luo Y, Chen X, O’Donnell MA (2003) Role of Th1 and Th2 cytokines in BCG-inbuced IFN-γ production: cytokine promotion and stimulation of BCG effect. Cytokine 21:17–26CrossRefPubMed
71.
Hara I, Nagai H, Miyake H et al (2000) Effectiveness of cancer vaccine therapy using cells transduced with the interleukine-12 gene combined with systemic interleukin-18 administration. Cancer Gene Ther 7:83–90CrossRefPubMed
72.
Nagai H, Hara I, Horikawa T et al (2000) Antitumor effects on mouse melanoma elicited by local secretion of interleukin-12 and their enhancement by treatment with interleukin-18. Cancer Invest 18:206–13PubMedCrossRef
73.
Saint F, Patard JJ, Maille P, Soyeux P, Hoznek A, Salomon L et al (2001) T-helper 1/2 lymphocyte urinary cytokine profiles in responding and nonresponding patients after 1 and 2 courses of bacillus Calmette-Guerin for superficial bladder cancer. J Urol 166:2142–2147CrossRefPubMed
74.
Arnold J, de Boer EC, O’Donnell MA, Bohle A, Brandau S (2004) Immunotherapy of experimental bladder cancer with recombinant BCG expressing Interferon-gamma. J Immunother 27:116–123CrossRefPubMed
75.
Yu DS, Lee CF, Hsieh DS, Chang SY (2004) Antitumor effects of recombinant BCG and interleukin-12 DNA vaccines on xenografted murine bladder cancer. Urology 63:596–601CrossRefPubMed
76.
Lunardi C, Bason C, Navone R et al (2000) Systemic sclerosis immunoglobulin G autoantibodies bind the human cytomegalovirus late protein UL94 and induce apoptosis in human endothelial cells. Nat Med 6:1183–1186CrossRefPubMed
77.
78.
Buchs N, Chevrel G, Miossec P (1998) Bacillus Calmette-Guerin induced aseptic arthritis: an experimental model of reactive arthritis. J Rheumatol 25:1662–1665PubMed
79.
Dulphy N, Peyrat M-A, Tieng V et al (1999) Common intra-articular T cell expansions in patients with reactive arthritis: identical α-chain junctional sequences and cytotoxicity toward HLA-B27. J Immunol 162:3830–3839PubMed
80.
Shoenfeld Y, Vilner Y, Coates ARM, Rauch J, Shaul D, Pinkhas J (1986) Monoclonal antibodies react with DNA, and monoclonal anti-DNA autoantibodies react with Mycobacterium tuberculosis. Clin Exp Immunol 66:255–261PubMed
81.
Lindqvist KJ, Coleman RE, Osterland CK (1997) Autoantibodies in chronic pulmonary tuberculosis. J Chron Dis 22:717–725CrossRef
82.
Thorns CJ, Morris JA (1985) Common epitopes between mycobacteria and certain host tissue antigens. Clin Exp Immunol 61:323–328PubMed
83.
Glynn P, Weedon D, Edwards J, Suckling AJ, Cuzner ML (1982) Humoral immunity in chronic relapsing experimental autoimmune encephalomyelitis. The major oligoclonal IgG bands are antibodies to mycobacteria. Neurol Sci 57:369–384CrossRef
84.
Van Eden W, Holoshitz J, Nevo A, Frenkel A, Klajman A, Cohen IR (1985) Arthritis induced by a T-lymphocyte clone that responds to mycobacterium tuberculosis and to cartilage proteoglycans. Proc Natl Acad Sci USA 82:5117–5120PubMedCrossRef
85.
Prescott S, James K, Busuttil A, Hargreave TB, Chisholm GD, Smyth JF (1989) HLA-DR expression by high grade superficial bladder cancer treated with BCG. Br J Urol 63:264–269PubMed
86.
87.
Wick G, Perschinka, Millonig G (2001) Atherosclerosis as an autoimmune disease: an update. Trends Immunol 22:665–669CrossRefPubMed
88.
Zugel U, Schoel B, Yamamoto S, Hengel H, Morein B, Kaufmann SH (1999) Crossrecognition by CD8 T cell receptor αβ cytotoxic T lymphocytes of peptides in the self and the mycobacterial hsp60 which share intermediate sequence homology. Eur J Immunol 25:451–458CrossRef
89.
Hara I, Sato N, Miyake H, Muramaki M, Hikosaka S, Kamidono S (2004) Introduction of 65 kDa antigen of Mycobacterium tuberculosis to cancer cells enhances anti-tumor effect of BCG therapy. Microbiol Immunol 48:289–295PubMed
90.
de Boer LC, Steerenberg PA, van der Meijen APM et al (1992) Impaired immune response by Isoniazid treatment during intravesical BCG administration in the guinea pig. J Urol 148:1577–1582PubMed
Metadata
Title
Reactive arthritis following BCG immunotherapy for urinary bladder carcinoma: a systematic review
Authors
Elisa Tinazzi
Vincenzo Ficarra
Sara Simeoni
Walter Artibani
Claudio Lunardi
Publication date
01-04-2006
Publisher
Springer-Verlag
Published in
Rheumatology International / Issue 6/2006
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-005-0059-2

Other articles of this Issue 6/2006

Rheumatology International 6/2006 Go to the issue

Original Article

General or personal diet: the individualized model for diet challenges in patients with rheumatoid arthritis

Original Article

Serum interleukin-18 levels in patients with Behçet’s disease. Is its expression associated with disease activity or clinical presentations?

Original Article

Prevalence of low central bone mineral density in a bulgarian female referral population: a pilot study

Original article

Hand disability and related variables in patients with rheumatoid arthritis

Original article

Balneotherapy in rheumatic diseases–an overview of novel and known aspects

Case Report

Impact of pain severity and location on health-related quality of life

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits