The Development of Inflammatory Arthritis and Other Rheumatic Diseases Following Stem Cell Transplantation

• Published in: Seminars in arthritis and rheumatism 2009-08, Vol.39 (1), p.55-60
• Main Authors: Barnabe, Cheryl C.M., MD, FRCPC, LeClercq, Sharon A., MD, FRCPC, Fitzgerald, Avril A., MD, FRCPC
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; antiphospholipid antibody syndrome; arthritis; Arthritis - etiology; Arthritis - immunology; Arthritis - physiopathology; autoimmune disease; Autoimmune Diseases - immunology; Autoimmune Diseases - physiopathology; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Diseases of the osteoarticular system; eosinophilic fasciitis; Female; Humans; Immunity - immunology; Immunity - physiology; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Rheumatic Diseases - etiology; Rheumatic Diseases - immunology; Rheumatic Diseases - physiopathology; Rheumatology; spondyloarthropathy; stem cell transplantation; Stem Cell Transplantation - adverse effects; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Young Adult
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2008.03.010

Objectives Despite the use of stem cell transplantation (SCT) to treat inflammatory arthritis and other rheumatic diseases, case reports of the paradoxical development of these diseases after SCT are appearing. Three cases of inflammatory arthritis developing after SCT were seen at our institution, leading to a literature review to determine the association between SCT and the de novo development of rheumatic conditions. Methods Using PubMed and manual searches of references from pertinent articles, the literature pertaining to the onset of rheumatic conditions following SCT was identified. Results Case reports detailing the onset of rheumatoid arthritis, HLA-B27-related spondyloarthropathy, psoriatic arthritis, systemic lupus erythematosus, vasculitis, eosinophilic fasciitis, antiphospholipid antibody syndrome, as well as polyarthritis related to intercedent viral infection were identified. Failure of transmission of autoimmune disease from donor to recipient in 2 case reports is also summarized. Conclusions The incidence of rheumatic disease development after SCT is unknown, and reported cases may simply reflect those patients who were predisposed to disease development in the first place. However, immunologic manipulation during the SCT process raises the question of whether there is an increased propensity to develop autoimmune disease posttransplant. Clinical vigilance in the recognition of phenotypic changes and clinical events occurring after SCT which may represent new autoimmune phenomena is required.