Managing rheumatoid arthritis and cancer: 5 insights

Rheumatoid arthritis is an autoimmune disease that causes inflammation and swelling in the joints. It’s caused when the immune system mistakenly attacks the joints which are the parts of the body that connect two or more bones. If left untreated, it can cause stiff, swollen, painful joints and lead to difficulty moving.  

Patients with rheumatoid arthritis may focus on controlling symptoms, but patients who also have cancer may need to change their treatment plan to focus on treating the cancer. 

Maria Suarez-Almazor, M.D., Ph.D., and Maria Lopez-Olivo, M.D., Ph.D., share five insights about rheumatoid arthritis and cancer treatment.  

1. Rheumatoid arthritis patients with cancer should seek multidisciplinary care

Managing a cancer diagnosis and rheumatoid arthritis is complex. It usually requires the skills of a multidisciplinary team, as we have at MD Anderson. 

Most treatment guidelines suggest reevaluating rheumatoid arthritis treatment if a patient is also diagnosed with cancer. So, a multidisciplinary care team will ensure that your oncologist works closely with your rheumatologist to discuss your treatment options, both for the cancer and rheumatoid arthritis.

Your care team will take into account how severe your rheumatoid arthritis symptoms are, which treatments you’re on, and the specifics of your cancer diagnosis and treatment options. Based on these factors, they’ll come up with a personalized plan for you.

2. Some rheumatoid arthritis medications are also used to treat cancer

You may recognize some of the treatments you’re prescribed for cancer since some of those same medications may also be used to treat rheumatoid arthritis. 

Because rheumatoid arthritis treatments are designed to suppress the immune system, some have been used for cancer treatment. Most patients with rheumatoid arthritis initially receive a type of medication called disease-modifying anti-rheumatic drugs. Also known as DMARDs, these drugs slowly work to reduce inflammation in the joints and reduce pain. An example is methotrexate, which has been used at much higher doses than those used to treat rheumatoid arthritis for some cancers, including leukemia, lymphoma and breast cancer.  

When disease-modifying anti-rheumatic drugs don’t offer relief, immunosuppressive biologic disease-modifying anti-rheumatic drugs may work to control inflammation in the joints. Some of these drugs are also used to treat severe cases of immune-related adverse events that may occur with cancer immunotherapy, a novel type of cancer treatment, including immune checkpoint inhibitors or CAR T cell therapy.

3. Most rheumatoid arthritis treatments don’t increase your risk for secondary cancers

Traditional disease-modifying antirheumatic drugs do not increase your risk of developing cancer.  

If DMARDs don’t improve your rheumatoid arthritis symptoms, your care team may recommend biologic or targeted synthetic disease-modifying anti-rheumatic drugs. Biologic drugs target molecules in the cells of the immune system, and targeted therapies block molecules on immune and other types of cells in your body.

We found in a previous study examining clinical trials in patients with rheumatoid arthritis that biologic drugs did not significantly increase the risk of developing cancer. However, because these types of drugs interfere with the immune system, there have been some concerns that some of these agents, especially targeted drugs, may slightly increase the risk of cancer.  

For patients with rheumatoid arthritis who develop cancer, there are several options for treatment, including traditional and biologic therapies that can be used safely without any evidence that they will cause cancer to spread or make recurrences more likely.

4. Cancer immunotherapy treatments may worsen rheumatoid arthritis

Because cancer immunotherapy activates your immune system so that your immune cells can attack your cancer, it may worsen the symptoms of autoimmune diseases such as rheumatoid arthritis. 

With CAR T cell therapy, for instance, a patient’s T cells are engineered to treat cancer, but it can cause the release of cytokines into the blood from immune cells. In some cases, it can be life-threatening, but biologic disease-modifying anti-rheumatic drugs can help calm the immune reaction.

If you have rheumatoid arthritis or another autoimmune disease, it’s important to talk to your doctor about your treatment options. Your care team can help manage any side effects of treatment.

5. Avoiding additional illnesses is important

Since rheumatoid arthritis treatment suppresses the immune system, patients are at higher risk of infections, like the common cold, flu or even COVID-19, etc. 

Cancer treatments such as chemotherapy and targeted therapy can also weaken the immune system. This can make cancer patients more likely to get sick. So, your care team will monitor you closely to watch for adverse side effects of treatment.  

It’s important to take extra care to protect yourself from getting sick while you’re going through treatment. This means getting your immunizations up to date, such as pneumonia, COVID-19 and flu shots and taking precautions to protect yourself from COVID-19. 

You should also avoid tobacco and limit alcohol. Tobacco is the most significant lifestyle risk for cancer. It is associated not only with lung cancer but also with throat cancer, mouth cancer, bladder cancer, pancreatic cancer and others.

Additionally, for cancer prevention, it’s best not to drink alcohol. Drinking any amount of alcohol increases the risk for several cancers, including breast cancer, colorectal cancer, esophageal cancer, liver cancer, oropharyngeal cancer and stomach cancer. While no alcohol is best, women who choose to drink should have no more than one drink a day, and men no more than two drinks a day.

Keeping your immune system as healthy as possible can help with both cancer treatment and rheumatoid arthritis.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.