Bladder Cancer, BCG Treatment, and Reactive Arthritis
Bladder cancer can be described as non-muscle invasive or muscle-invasive. Non-muscle invasive means the cancer is only on the surface of the bladder. Invasive means that the cancer is deeper in the bladder.1 Treatment plans depend on which type of cancer you have. For non-muscle invasive bladder cancer, a common treatment is Bacillus Calmette-Guérin (BCG) therapy.1-2 While this treatment can be very helpful, there may be side effects that can vary from person to person. One possible rare side effect that we are focusing on in this article is reactive arthritis.3
What is BCG therapy?
BCG therapy is a type of immunotherapy. Immunotherapy uses your body’s natural defense, the immune system, to fight cancer.4 BCG is a type of bacteria. Even though we’re often told that bacteria are harmful, these bacteria are weak, so they help you instead of making you sick.4 Doctors put the bacteria into your bladder, which causes your immune system to then fight the bacteria and the cancer at the same time.1
How does BCG therapy fight cancer?
Doctors think BCG attaches to cancer cells.2 Since BCG is a type of bacteria, your body sees it as an intruder and fights it. Because BCG is attached to the cancer, the body ends up fighting the cancer too.2
When would I get BCG therapy?
BCG therapy is used for early-stage bladder cancer.1 Your doctor may suggest BCG therapy after a transurethral resection of bladder tumor (TURBT) procedure.3-4 The TURBT is used to remove tumors from the bladder, but some cells may remain and others can grow back, so BCG therapy is often used after a TURBT procedure to keep the cancer away.1
What are the common side effects of BCG therapy?
Some people say they urinate more often or that they see blood in their urine. Others say they just feel unwell or have flu-like symptoms. People also say that BCG therapy has caused bladder swelling and pain when urinating for them. 1
Rare side effects of BCG therapy include reactive arthritis
In some cases, people on BCG therapy can get reactive arthritis.5 This means their bodies react negatively to the therapy, which causes their joints to swell. The joint pain can be bad enough to affect a person’s daily routine.3
What are the symptoms of reactive arthritis?
People with reactive arthritis have a lot of joint pain and swelling. They feel stiff and achy, especially in their knees and ankles. Many people also feel pain in their hands, wrists, and feet. The pain can be on both sides of your body, such as both knees, or just one.3,5
Why does BCG therapy cause reactive arthritis?
Doctors really do not know why some people on BCG therapy get reactive arthritis. One thought is that BCG activates the immune system too much.3,6 By doing this, the body attacks itself. The result is swelling and pain in your joints.
Is reactive arthritis genetic?
There could be a gene involved in reactive arthritis. Doctors are still trying to figure out how this gene could help predict who will get reactive arthritis. 5,7 More research needs to be done on the genetics of this condition.
Does everyone on BCG therapy get reactive arthritis?
Reactive arthritis is not a common side effect of BCG therapy. One study reported less than 5 out of 100 people had symptoms of reactive arthritis. 3 It affects more males than females. A recent study showed that most people with reactive arthritis noticed symptoms after 5 or more BCG treatments.5
How do doctors treat reactive arthritis?
Reactive arthritis is hard to diagnose. You may have to see a specialist or get blood tests.7 Reactive arthritis is treated with drugs called nonsteroidal anti-inflammatory drugs (NSAIDS) and corticosteroids.5 NSAIDS are drugs like aspirin or ibuprofen. Corticosteroids look like chemicals your body already makes.8 Both of these drugs help with pain and swelling but in different ways. Studies show both drugs are successful in treating reactive arthritis.
Do I have to live with reactive arthritis forever?
Once the drugs are started, 9 out of 10 people are symptom-free within 6 months. If you have symptoms of reactive arthritis, you may have to stop or change your BCG therapy. 5 Your doctor will work with you to find the best treatment option.
Should I get BCG therapy if there is a risk of arthritis?
BCG therapy is highly recommended for the treatment of non-muscle invasive bladder cancer. It lowers your risk of the bladder cancer coming back.3 It does come with side effects, but reactive arthritis is rare. 3 Talk to your doctor about any concerns you have about the side effects of this therapy.
Have your views towards bladder removal changed since you were diagnosed?