What is immunotherapy induced arthralgia?

Immunotherapy is a treatment for cancer that helps the immune system recognise, target, and eliminate cancer cells wherever they are in the body. Many cancers employ methods to hide themselves from the body’s immune cells. Immunotherapy blocks these evasion strategies, so the body’s immune system can recognise and kill the cancer cells.

In some people, immunotherapy can also cause the immune system to attack normal tissues within the body, causing inflammation.

Arthralgia, or joint pain, occurs when joints in the body become inflamed and, as a result, can be quite painful and sometimes swollen. Blood tests and x-rays may sometimes be needed to help diagnose this problem.

Who does it affect?

Some patients with pre-existing joint conditions, such as rheumatoid arthritis, may find that the immunotherapy treatment worsens their symptoms and causes flare-ups of arthralgia.

How can it be treated?

Sometimes pain relief will not help in reducing the swelling in your joints. If you are experiencing symptoms, you should let your oncology team or specialist nurse know.

If your symptoms start to affect your daily activity and do not settle, or are not controlled well with pain relief, then you may be given steroids, also known as corticosteroids, to help reduce the swelling in your joints. If you start taking steroids, your immunotherapy treatment could be delayed until your arthralgia symptoms remain under control.

Everyone is different and each person’s body responds differently. You will be monitored closely when you are on steroids to check they are working to reduce your symptoms. If your symptoms do not improve on steroids, there are other drug options. We will often ask for input from a rheumatologist if your symptoms don’t settle as expected.

Taking steroid tablets for less than three weeks is unlikely to cause any significant side effects. However, you may get some side effects if you need to take them for longer or at a high dose. Often, patients experience no side effects from steroids.

Side effects of steroid tablets can include:

  • Indigestion or heartburn.
  • Increased appetite, which could lead to weight gain when used long term.
  • Difficulty sleeping.
  • Changes in mood and behaviour, such as feeling irritable or anxious.
  • An increased risk of infections – especially chickenpox, shingles, and measles.
  • High blood sugars or diabetes.
  • Weakening of the bones (osteoporosis).
  • High blood pressure.
  • Cushing's syndrome – which can cause symptoms such as thin skin that bruises easily, a build-up of fat on the neck and shoulders and a red, puffy, rounded face.
  • Eye conditions, such as glaucoma and cataracts.
  • Mental health problems, such as depression or suicidal thoughts.

Most side effects will pass once treatment stops. Tell your doctor or nurse if you notice any new symptoms. If possible, you should take your steroids in the morning to reduce trouble sleeping. You will be given a tablet to take alongside your steroids to protect your stomach from irritation and it is also recommended to take your steroid tablets with food.

If you are on steroids for more than three weeks, your doctor or specialist nurse might prescribe a bone strengthening drug to prevent the weakening of your bones and a low dose of antibiotics to prevent you from getting an infection.

What can I do to help my symptoms?

Regular exercise and moving your joints will help to keep you active. Eating a healthy, balanced diet can reduce the impact of arthralgia symptoms.