Do Rheumatoid Arthritis Drugs Cause Cancer?

junkyard transmissionHopefully not.

People often state that drugs used to treat Rheumatoid Arthritis cause cancer as an accepted fact. They say they that shortening the length of life is worth the quality of life they gain from treatment. Personally, I’m tremendously interested in both.

Rheumatoid Arthritis has long been known to increase risk of cancer, especially lymphoma. We know about Rheumatoid heart disease and other things that contribute to the RA mortality gap. Balancing medication risks is a big deal for RA patients: We’d like to know whether our medications are adding to our days or taking away.

If it’s a fact that Rheumatoid Arthritis drugs cause cancer, then why is it so hard to prove?

Because it might not be true. And the problem is very complex.

One reason is the nature of tumor necrosis factor (TNF) which is involved with RA. While one purpose of TNF is to kill tumor cells, it is also multifunctional. TNF is involved in both cell death and cell proliferation! “The dual nature of TNF-a activity may be responsible for its paradoxical anti- and protumor activities depending on the cell, environment, dose, and other factors.”1

RA patients are at higher risk for lymphoma, while lymphoma patients are not at higher risk for RA. And the more severe the RA is, the higher the risk lymphoma. One frequently-quoted study from 2006 says people with severe RA have a 70 fold increased risk of lymphoma.

DMARDs (disease modifying antirheumatic drugs)

Some drugs that are used as DMARDs have been associated with increased cancer risk: azathioprine (Imuran) and cyclophosphamide (Cytoxan). We must remember that an association does not prove causation, but to patients, it may represent risk. Perhaps that is a reason those DMARDs are less frequently used. The most common DMARD, methotrexate, was feared to be associated with increased lymphoma risk about a decade ago, but since then, several large analyses have shown no correlation.

TNF inhibitors

Many of us have read a package insert for a TNF inhibitor, naming cancer as one of the possible risks noted during clinical trials. However, some large studies over the last few years suggest that RA may be more implicated than TNF inhibitors in the increased number of cancer tumors in RA patients.

Here’s an intriguing point: “Also the types of lymphomas observed in patients treated with anti-TNF-a treatment were predominantly B cell lymphomas, similar to that observed in patients with RA, lending support to the hypothesis that these lymphomas were related to the underlying arthritis rather than its treatment. Following this, a meta analysis of 18 studies including 8,808 RA patients by Leombruno did not find an increased incidence of lymphoma or any nonhematologic cancer in patients treated with anti-TNF therapy.”1

However, one 2007 study found that while overall cancer risk was not increased and tumor risk was not greater, skin cancers were increased with Biologic use.2

Recommended reading used as references for this post:

1Downloadable PDF “TNF-α inhibitors: are they carcinogenic?” which is available at this link from Dovepress that was posted by a reader. Go through some of the 53 footnotes about cancer, autoimmune disease, and TNF.

2Biologic treatment of rheumatoid arthritis and the risk of malignancy: analyses from a large US observational study” on PubMed

2009 Swedish study reported in MedpageToday

Do rheumatoid arthritis and lymphoma share risk factors?: a comparison of lymphoma and cancer risks before and after diagnosis of rheumatoid arthritis” on PubMed

Complications of Anti-TNF Therapies: Do Anti-TNF Drugs Increase the Risk of Malignancies?” on Medscape

Edit 8/17/11: Another article based on a new study of relationship of cancer to several biologics.

More posts on Biologics on RA Warrior:

Kelly Young

Kelly Young is an advocate providing ways for patients to be better informed and have a greater voice in their healthcare. She is the president of the Rheumatoid Patient Foundation. Kelly received national acknowledgement with the 2011 WebMD Health Hero award. Through her writing, speaking, and use of social media, she is building a more accurate awareness of Rheumatoid disease aka Rheumatoid Arthritis (RA) geared toward the public and medical community; creating ways to empower patients to advocate for improved diagnosis and treatment; and bringing recognition and visibility to the Rheumatoid patient journey. In 2009, Kelly created Rheumatoid Arthritis Warrior, a comprehensive website about RA of about 950 pages and writes periodically for other newsletters and websites. Kelly served on the Mayo Clinic Center for Social Media Advisory Board. There are over 42,000 connections of her highly interactive Facebook Fan page. She created the hashtag: #rheum. Kelly is the mother of five, a home-schooler, Bible teacher, NASA enthusiast, and NFL fan. You can also connect with Kelly by on Twitter or YouTube, or LinkedIn. She has lived over nine years with unrelenting Rheumatoid disease. See also http://www.rawarrior.com/kelly-young-press/

24 thoughts on “Do Rheumatoid Arthritis Drugs Cause Cancer?

  • March 30, 2011 at 9:50 am
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    The increased cancer risk is one of those things that scares me so badly that I tend to stick my head in the sand like an ostrich.

    Reply
    • March 31, 2011 at 9:10 am
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      I’m very familiar w/ the ostrich defense – it still is part of my battle sometimes. It’s a natural thing to look away when it’s too hard. ♥

      Reply
  • March 30, 2011 at 9:55 am
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    Thanks for addressing this issue. I commented on my journey with RA and lung cancer (not lymphoma) on the Reliable Sources: Orencia Cough Side Effect & Notions of e-Patients blog. It is a tricky road. RA can affect the lungs. Many of the RA drugs can have lung side effects though lung cancer is rarely mentioned. Once on the lung cancer journey, getting into clinical trials, even with the right tumor markers, is denied by having RA, at least that was my experience. Again I’d like to stress that newly diagnosed RA patients should be given a base-line chest x-ray, something I did not have but in later reading found it was recommended for the newly diagnosed. Having cancer and taking the RA meds is a mental roller coaster. As I said earlier, I was determined to never swallow another Methotrexate after each cancer surgery, but found myself totally dysfunctional with RA flares. I finally relented to taking the minimum possible dose to allow better quality of life not knowing how much life I had left! I am in a good place at the moment…the cancer is NED and my RA is manageable most days. I do wish there were more studies on RA and lung cancer and on the issue of suppressing the immune system in RA and the new immunotherapy treatments for cancer. I am not trying to scare anyone; my goal is to increase awareness to these particular issues. I might mention that I grew up in a home with a smoker and have lived in high radon areas. I have a family history of cancer, though no lung cancer. I may just have unlucky genes.

    Reply
    • March 31, 2011 at 9:12 am
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      Sheryl,
      Thanks for adding your information to this discussion. We do need to keep studying all these things!

      Reply
  • March 30, 2011 at 12:46 pm
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    kelly,
    I have done a wee bit of research on this subject. The rumy drugs that I took all gave me stomach ulcers, that’s why I stick to more natural methods for relief. when I was 60 I was diagnosed with stage 2 her2 positive breast cancer. I had a double masectomy & was treated with chemo infusions. the lymph nodes under my right arm were removed as well. I have had some lymphodemia symptoms. I opted for reconstruction & I got a bacterial infection & the implants were removed in Dec. In Jan. I started breaking out in hives & each day they get worse. Benedryl used to help now it does nothing. I have learned that Moffitt Cancer Center (where I was treated) does not know a lot about the interaction of cancer & rhumy. I am awaiting a call from their dermatologist who they referred me to. I will keep you informed of the dr. findings.

    Reply
    • March 30, 2011 at 1:50 pm
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      I too had a bout with chronic hives after my surgery in Oct 2009 when more “clips” were placed in my lung and I had several CAT/PET scans with contrast, not to mention the antibiotics, etc. I was treated with Allegra and by July, the hives were finally gone. The dermatologist and surgeon don’t know what caused them.

      Reply
  • March 31, 2011 at 5:21 am
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    I know the problem I am having of late is my lack of confidence in our FDA and the reporting systems in this country as a whole. We have had soooo many drugs pulled, changed insert data on a continuing basis to “warn” patients, recalls, etc. etc. I personally don’t have much confidence in the drug trial studies anymore and I do question the monetary link to many of our drug releases to market as being motivated by a ROI (return on investment) rather then improvement on health issues. Again, this is just my personal experience but one founded on being run through the ringer with ra, two thyroid cancers, multiple drug reactions, and a scare of biopsies of my lymph glands etc. etc. And my biggest concern is the reporting systems we don’t have in place in this country. For example, if someone dies say of a heart attack and is taking multiple medicines…what and who is reported to for followup to insure that one or a multiple of their meds was not responsible. Who reports all of this? Who reports allergic reactions or side effects? I am definatly not convinced that our ra docs report all of this…or for that matter…any doc! Who is responsible for the reporting and do they actually do it?

    In the past couple years I noticed that Enbrel is being used by pregnant woman. No studies have been conducted on pregnant women for any TNF that I know of…so basically these women and their unborn a babies are being used as the test samples. And their ra docs are prescribing these meds knowing they are pregnant! This company even ask that these women register with them while taking this med while pregnant. Something is very wrong with this in my opinion. And this is no “study” group…this is regular people who have no clue what the long term impact might be to their babies.

    RA and these autoimmune diseases can be very painful and I know personally I would try just about anything to get relief so I do understand why these women might be willing to use this med. But how can a doctor even prescribe it when they have an oath to first…do no harm. No one knows the long term implications on a fetus or for that matter any of these newer meds. I actually saw a commercial for one newer RA med that stated it had only been studied for two years. TWO YEARS!!! Are you kidding me! Look what happened with the use of hormones for the relief of menapause.

    If you are not familiar with this…after hormones where no longer prescribed to woman, there was a huge decrease in breast cancer. It was later found that hormone prescriptions where linked dramatically to the cause of breast cancer. This was found out only after the prescriptions where stopped. Yup….that is some great reporting system…NOT…in my opinion.

    I would love to feel safe with our FDA but unfortunately I no longer can. Burn me once, shame on you…burn me twice…shame on me. Unfortunately, I take all information with a grain of salt which is rather scary considering the ramifications or possible implications on my personal well being or even my life for that matter. And I personally will never touch a med (unless I am on death’s door) that has not been out on the market for at least seven years. I figure by this time any “problems” I will be able to track down through European studies. Yup, I don’t trust our own in this country…so I look elsewhere.

    Oh and least we not forget the recent discontinuation of that pain med that was out on the market for 50 years and now…all of a sudden…is suspect of causing (if I remember correctly) heart problems. Are you kidding me! Fifty years to find this out!!!

    Yup..scary in my opinion.

    Reply
    • April 2, 2011 at 8:35 am
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      I appreciate your desire to use a natural approach to your RA treatment. There are some very scary meds out there and I’ve had my share of side effect caused emergency medication changes. I hope you are working w/ a rheumatologist who can support you in your natural approach. I made the unfortunate mistake of finding ways to handle the pain and joint swelling through meditation and natural products without physician support. My joints felt great, so imagine my surprise at my next visit to my primary care doctor telling me my labs and other tests were indicative of muscle wasting,blood vessel damage, and chronic inflammation induced cysts. This disease is tricky. Needless to say, while I still use meditation and lifestyle choices to manage much of the pain, I’m back w/ the DMARDS to keep the rest of me safe.

      Reply
      • April 15, 2011 at 7:25 pm
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        Unfortunately for me the only DMRADS left all are out of my price range (my insurance does not cover them) or their labels mention cancer risks. I have a horrific cancer history in my family. I have done all the meds already up to and including the tnfs. The only ones I have not tried are the infusion ones and only because I have horrific drug allergies as well. I have no doubt that the ra is causing damage but it was also causing damage when I was even on these drugs and sometimes 3 to 4 at a time combined. I am currently only taking pregnisone in a small dose and yes, I am well aware of the side effects of this med as well. I have had ra for about 12 years now and kinda feel like I am damned if I do and damned if I don’t. I did recently start taking something called Chicken Cartiledge II which was supposedly studied and found to be as effective as methotrexate. I have my fingers crossed. And no my ra doc basically told me I should find another doctor unless I accept prescriptions because that is what he feels is his role…to write prescriptions. I had a great ra doc but we moved and now I am back to the drawing board and quite feed up with it all. I am sure I will have to get back out there and find a good doc but I do understand your concerns for the impact the ra is having on you. What scares me even more is that even with taking all of these meds….mine continues to march on. It was my ra doc (not the one here) that pulled me off the meds. I didn’t do it on my own. I also have some other weird stuff going on in my body and I think that was also a concern for her…liver cyst that was growing, swollen lymph glands that had to be biopsied but came as inflammation not cancer (thank goodness). And my list of med allergies is riducously long as well which complicates the med issue also. I use to carry an epi pen with me at all times due to my allergic reactions. And the really scary part was I could be taking a med for years and then blame..a horrific reaction out of now where. Alot of my reluctance is the allergy issues….if you have ever had an anaphalatic reaction, you would understand.

        In any case, I have my hopes crossed (never my fingers 🙂 that the Chicken Carteledge II works out for me. I also started Evening Primrose oil and I also do Ultram for the pain. I know I need something but am really gun shy to go back down that med road again. But like I said, if it becomes life threatening then I will have no choice I suppose.

        Yup…damned if I do and damned if I don’t.

        Reply
          • April 16, 2011 at 9:57 am
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            Thank you so much. This road isn’t always an easy on to travel but with a little help from our friends…we just may make it.

  • April 7, 2011 at 2:44 pm
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    Just wanted to mention – my youngest child has JRA and my eldest had Neuroblastoma – not sure if these disorders are linked in any way at all gene wise

    Reply
    • April 8, 2011 at 10:54 am
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      Wow, you have a lot on your plate, Kelly. I keep reading for new research on these things. Wish I were 20 and I’d go into the research field!

      Reply
  • May 25, 2011 at 6:21 am
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    Just had a follow-up appointment with my oncologist today. My rheumatologist wants me to start Humira, or perhaps another biologic. Sure enough, the onologist says as a cancer survivor I should avoid Humira and any other TNF blockers. Categorically. He says TNF blockers are not recommended for cancer survivors. Sorry I don’t have the pertinent medical details, but I wanted to pass this along to those of you with RA that have also fought cancer. Not sure what I’m going to do for treatment; doesn’t look like methotrexate is going to do the trick with the Plaqunil and Sulfasalazine that I’ve been taking. And of course we are trying to slowly wean me off the low dose daily prednisone (10 mg/day). Not sure there are any more meds currentaly available to consider! Sigh.

    Reply
    • October 4, 2011 at 3:37 am
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      I have RA and was on various meds for the past year. Tried cimzia for 3 mos. and went off it when it didn’t work. I inject methotresdate once a week and prednizone 10 mg a day,
      I was recently diagnosed with breast cancer, so yes, I am concerned that these drugs played a part, and once I have my lumpectomy and treatment I need to question how safe these Ra drugs are to continue. It is very frustrating.

      Reply
      • October 4, 2011 at 7:50 pm
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        I hope the surgery and treatment go well Helene. I have not seen a link with breast cancer and RA. There is about a 10-12% lifetime risk of BC and about a 8.6% lifetime risk of inflammatory arthritis disease, so you may have very unlucky genes to get both. Either way, I wish you a complete recovery.

        Reply
  • December 2, 2011 at 1:46 pm
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    Now I am really confused & scared. I was dx in 2002- was on mtx/pred then plaquenil- I haven’t been on any RA meds for 7 years now- only pain meds for some daily functioning ability. My ra is now at the moderate to severe stage & with the risk of lymphoma increasing at this stage I’m frightened…
    I have an extremely strong family hx of cancer in my family, from my dad’s pancreatic/colon cancer leading to his death when I was 7, my sister’s Hodgkin’s disease (lymphatic cancer) leading to her death when I was 16, to my mom’s breast cancer & still surviving (Thank God!) 4 years ago after a mastectomy & lymph node removal; I tremble with fear when I feel my lymph nodes staying continuously swollen & my RA progressing without any relief. I keep praying for some type of insurance bc I can’t afford to go to the dr right now- (I’ve never admitted that & it kills me)-
    I really don’t know if there will be any med options for my RA considering my family hx & I’m not sure if I want to take the risk (like murph) … Oh & I have to take hormone replacement bc I had a total hysterectomy when I was 29. Hell of a med hx eh? not even 1/2 of it lol (comic relief-)
    ok- deep breath, had to get this out – thanks Kelly & God bless all of you RA & chronically ill warriors out there! ((HUGS)) & PRAYERS 2 U all!

    Reply
  • May 28, 2012 at 7:51 pm
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    I worry about the drugs causing cancer and who knows what else. I was dx in August 2011, very aggressive RA. In the 3 months I waited to get in to see a rheumatologist I went from a slight limp and some carpal tunnel-like symptoms to being unable to do anything for myself and barely able to walk a few steps. It terrified me.

    The rheumy put me on mtx, celebrex and prednisone. I got better – a lot better. A few months later, I had to have a total hysterectomy – my uterus and both ovaries were huge and misbehaving. An oncologist did the surgery because all my drs were thinking it might be cancer even tho the tests were inconclusive. Thank goodness it wasn’t – but why did my uterus and ovaries suddenly do that just a few months after I started the meds?

    So I was off the meds for a week before until two weeks after the surgery, then my rheumy put me back on them and added plaquinil.

    A few months later and I’m back in the hospital again with severe diverticulitus with a ruptured colon. They took me off all my RA drugs. I’ve been on antibiotics for a month now and was lucky to avoid a colostomy (so far) but I am scheduled to have about 8 – 10 inches of my colon removed in 2 weeks so this can’t happen again. My surgeon didn’t want me back on any of my RA meds because of my colon problems and the upcoming surgery, but when I called him in tears because I couldn’t even dress myself, he called my rheumy and finally said I could take the prednisone and celebrex. But he’ll be taking me off them this week to prep for the surgery.

    I feel so confused, frustrated and scared. If I take the meds, it helps, but I’m wondering if it’s a coincidence that I’m facing my 2nd surgery since starting the meds just 9 months ago. Before the RA meds, I never got sick, never went to the dr. Is this a coincidence?

    I keep trying to tell myself that this is it – after the colon surgery, I’ll get better and be able to get back on the mtx and other meds and get the RA back under control and get some semblance of a life back. Then I worry – if the meds are causing this, what’s next? And how can I NOT take the meds if I become completely incapacitated without them? I feel so trapped.

    Kelly, I really appreciate all you do to share info with RA’ers and educate everyone else to our plight. I still have a lot to read here but I haven’t seen or heard anything like my story – have you?

    Reply
    • August 27, 2012 at 6:30 am
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      Kathy S…..My heart bleeds for you. They hysto may have been just a freak thing, like an infection or irritation…not to worry. Prednisone and Celebrex are the demons that destroyed your colon….other meds that may help are Naproxin Sodium 550mg 2x daily under the counter and plaquenil along with Norco (opiate) 7.5/325 mg up to 3x daily….what even may help is Xanax, believe it or not for the pain…it helps with nerve pain and is a slight muscle relaxer….all this helps me…I was able to get married again! I am not like I used to be what so ever, but I can deal with it….best wishes to you my dear…

      Reply
  • September 2, 2012 at 4:09 pm
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    Thank you for the kind words Lauren. I can’t believe I posted that over 3 months ago – I’ve been living a nightmare ever since.
    I had the colon surgery, which went well, but I ended up back in the hospital a month later with a nasty c-diff infection. 11 days in the hospital then sent home on dificid (an antibiotic specifically for c-diff).
    After finishing the dificid, I asked my GI if I could take prednisone because my RA was really out of control (hardly no meds since April when this started – every time I try to take the prednisone for a little relief I get sick with something again). He said I could take it for a few days but 3 days into it I started having c-diff symptoms again – went to the doc and he said yes, a relapse, and the prednisone may have been part of the cause.
    I will finish the dificid for the c-diff relapse in 2 days but I don’t know how long it will be before I can take any of my RA meds. I now refuse to take celebrex after all I’ve read about it – I can’t see taking that risk when it really doesn’t seem to help my symptoms much.
    I’ve never heard of Xanax helping with RA. I’ve been on Vicodin 5mg, which they prescribed for the stomach pain, but now I mostly take it for the RA pain plus ibuprofen – is the naproxin better than ibuprofen? I’ve never tried it.
    I haven’t even seen the rheumy in months because I figure it won’t do any good. I can’t take any of the meds she wants me to take. I might hit the GI up this week to ask for something stronger for pain, but I won’t be surprised if he won’t do it.
    Thank you for responding to my post, and for letting me vent.

    Reply
    • September 19, 2012 at 10:27 pm
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      hi Kathy, did u get something for the pain? wondering how you’re doing.
      naproxen is considered tough on the stomach, but as to which one works better, it can depend on 2 things: how high of a dose you tolerate and genetics. Some like one or the other better. More people tend to get pain relief with ibuprofen according to some studies, but that is not at the regular otc dose. This is something your rheumatologist or your general dr should help you with – you should not have to live in terrible pain – since there are combinations of meds that can give you relief most of the time – not complete relief, but better at least.

      Reply
  • September 23, 2012 at 6:47 pm
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    Hi Kelly,
    Yes I saw my GI again 2 days ago and he gave me hydrocodone 7.5 with ibuprofen in it. He said I could take over the counter ibuprofen with it also, 3 or 4 at a time. I still haven’t taken any RA meds because I’m now suffering from the 2nd c.diff relapse. No prednisone this time to blame it on – it’s just a nasty infection that doesn’t want to go away. GI is getting creative this time with treatments after I begged him to make me better so I could take something for my RA. The pain pills are helping a little but really don’t cut it. Because of this latest relapse, I expect it will be at least a month before I can take any RA meds. The GI doesn’t want me taking anything hard on my intestines or anything that suppresses the immune system. That pretty much cuts out anything that might help my RA.

    My mother wants me to get some castor oil and try putting that on all of my joints. Have you ever heard of this? Or anything else I can try?

    Thanks again – so much!

    Reply
    • September 28, 2012 at 9:20 am
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      I don’t think so Kathy. Maybe thats an old wives tale? I never heard of that working although there are dozens of suggestions people give like that.
      But there is an nsaid that is like the advil (diclofenac) but you can rub it on joints in a lotion. it is a prescription and it does get absorbed into the blood stream so you would need to make sure you don’t take too much orally with it – ask the dr & pharmacist on this – but anyway it might help a little since you have to be so careful what you take into your stomach.
      I hope you recover from this relapse soon.

      Reply
  • June 4, 2014 at 10:28 pm
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    ***Warning: Gynecologic Content Contained***
    ****Disclaiimer****
    This information is based on my personal experience and is my opinion only. I am neither a physician nor medically trained in any way and have not even played one on tv. Please use this information only with clarification and under the advisement of your personal physician(s) only, and of course with your own common sense.
    Oh, and of course the information presented herewith does not necessarily represent those of Rheumatoid Warrior or any of its constituents therein.
    ——————–

    An open letter to fellow Rheumatoid Warriors:

    I just stumbled upon (and badly bruised my peace of mind as a result) an issue closely related to the cancer line of discussion but that I have not seen discussed, that of Human Papillomavirus (HPV) activation and immune suppression in Rheumatoid Disease.

    Before you reach for your Lysol wipes, let’s start some basic HPV information that is generally not known (per my doctor.)

    Without getting graphic, HPV is simply everywhere — surfaces, our hands, even the proverbial doorknob.

    While sexual contact is the likely means of transmissions, do not equate HPV infection with something like Chlamydia or Gonorrhea. It’s more like common Herpes type 1 – the once that causes the common cold sore.

    If you have Herpes Simplex, you know that it will activate in a normal (meaning non immune suppressed) person if their immune system is low, such as if they’re overly tired, haven’t been eating right, or have been ill. The same is true of HPV.

    But if generally healthy, the normal person can beat the virus’ activation down , or “clear” it, and they will have no symptoms. It doesn’t mean they are virus free, it just means the virus is no longer active and causing problems.
    My doctor told me that he believes nearly everyone has HPV by the time they’re a young adult. Officially the number is something like 75%, but the nature of its’ “here one minute, gone the next” nature makes it hard to pin down – especially in healthy people.

    Men should be aware of HPV, but it has less potential impact on their lives than for women. Especially immune suppressed women.

    Why is this information particularly important to us Rheumatoid Warriors? Virtually 99% of cervical cancer starts with HPV and we are at greater risk of HPV activation thanks to our immune suppressed status.

    The good news is that there have been major improvements to HPV tests. Tests can now be ordered that identify the specific strain(s)detected. The bad news is that this means more of us are getting abnormal PAP test results because the tests are more accurate and more specific.

    My gynecologist said that he now sees 3-4 patients every day with new positive HPV test results. It’s not that the infection is new, it’s that the tests are now better at detecting the virus.

    For us, our RD treatments render us immune suppressed, which means the virus is far more likely to be in an active state. Our immune suppressing drugs also may render us unable to beat the virus, or to “clear” it as we would if we were not immune suppressed.

    We are probably all aware that we are at greater risk of infection in general, but are not aware that this includes HPV activation.

    We have not had the benefit of sufficient education on these facts, so we may get blindsided by positive HPV test results.

    Important other facts to know about HPV:
    *It does NOT mean either partner has been unfaithful or withheld information. The virus could be latent in your system for years (and years) and just now become active with your immune suppression. And males are not likely to even know they have HPV. Usually, they have no symptoms.(So stop trying to identify the guilty party.)
    *It does NOT mean you have genital cancer, or genital warts.
    *It does NOT mean you have been overly free with yourself.
    * It DOES mean you need to take this seriously and definitely follow-up with your doctor.
    *DO make sure you learn which strain(s) of HPV you have (there are over 50 different strains identified and only a few are cancer related.)

    Knowing the exact strain of HPV (such as e6/e7 or e16/18) present will help direct you and your doctor on your course of action.

    The typical treatment may require follow-on procedures to “clear” the HPV infection. This might include biopsy, dilation and curettage, perhaps removal of epithelial layers from the cervix (depending on follow-up test results.) Obviously if cancer is detected, that would be an entirely different discussion.

    My personal recommendation is to avoid YouTube regarding these procedures. The method and procedures there may not be what your doctor recommends, and they will definitely cause a nightmare or two.

    Unfortunately for female RD patients, even once “cleared” of an active occurrence of HPV, re-infection is almost unavoidable. So the cycle of abnormal PAP results, HPV identification, biopsy, D&C, laser treatment may continue for the remainder of our immune suppressed lives.

    Note: Hysterectomy would not eliminate the problem, only cervical and uterine infection. (I asked.) HPV and cancer can develop anywhere in our reproductive anatomy.

    So why bother if it’s just going to come back? Because activation of the wrong strain of HPV can develop into cancer. Elimination when the virus is just a couple of layers deep is easy. Cancer treatment is a whole other game.

    In conclusion –
    At a minimum, it seems logical to this non-medical person that the following would be indicated:
    1. Inclusion of HPV-specific warnings/information with any immune suppressing agent.
    2. A concerted educational effort (hence this rant) through available avenues
    3. Recommendation of increased PAP frequency – perhaps to every 6 months for early detection for women taking immune suppressing agents.

    Female RD (and other immune suppressed disease) Warriors should be made aware of these very real facts of our immune suppressed lives. We should also insist – and you may have to ask your doctor for this at the time of your PAP test – on the HPV identification tests – especially for the e16/18 and the less risky e6/7 strains. We should also insist on PAP tests every 6 months to catch any activation early, and also be prepared for the necessary procedures and commitment to regular testing thereafter.

    ***Postscript***
    I will be taking this rant to my Rheumy (who is fantastic) in 5 days. Should this require any correction or update, I will do so immediately.

    Reply

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