Immunotherapy is a groundbreaking treatment that harnesses the power of your immune system to fight cancer and autoimmune diseases. Unlike traditional therapies that directly target cancer cells, immunotherapy boosts your body’s natural defenses to seek and destroy cancerous cells.[1] It has shown great success in treating allergies, autoimmune disorders and various cancers such as melanoma, bladder, lung, head and neck, esophageal and renal cell cancer.[2] Despite immunotherapy’s superstar status, side effects are possible. Along with common side effects like fatigue, rashes, and gastrointestinal issues, immunotherapy can cause joint and muscle pain and discomfort.[3]
Immunotherapy-Induced Arthralgia or Myalgia
Arthralgia (joint pain) and myalgia (muscle pain) are common side effects of immunotherapy.[4] Treatment can cause rheumatic immune-related adverse events (irAEs) and resemble musculoskeletal diseases like arthritis.[4] As the immune system becomes more active, it may mistakenly attack healthy tissues, leading to inflammation and pain in the joints and muscles.[3] Clinical trial patients have reported symptoms associated with arthritis, such as swollen, stiff joints, pain, and movement limitations.[4] If you have an existing arthritis diagnosis, immunotherapy, specifically immune checkpoint inhibitors (ICI), can irritate the condition but may be successfully managed with corticosteroids.[5]
Who Is Affected By Immunotherapy Joint and Muscle Pain?
Not everyone undergoing immunotherapy will experience joint or muscle pain, but it is a significant side effect for some.[2] Factors that may increase the chances of developing arthralgia and myalgia include cancer type, type of immunotherapy drugs used and your overall health and preexisting conditions.[6] Patients, regardless of age, who have a history of autoimmune diseases like rheumatoid arthritis (RA) may be more susceptible to experiencing joint swelling, discomfort, limited mobility and muscle aches.[4]
What Types of Immunotherapy Cause Musculoskeletal Pain?
Several types of immunotherapy can cause musculoskeletal pain. Immune checkpoint inhibitors (ICI), which block proteins that prevent the immune system from attacking cancer cells, are commonly associated with joint and muscle pain.[4] Examples of ICI drugs are pembrolizumab (Keytruda) and nivolumab (Opdivo).[7] Cytokines, another form of immunotherapy that boosts immune cell production[1], and CAR T-cell therapy[8], which involves modifying a patient’s T-cells to attack cancer cells, can also cause these side effects.
How Long Does the Pain Last?
The duration of joint and muscle pain from targeted therapy varies widely among patients. For some, the pain may be short-lived, lasting only a few days or weeks.[9] For others, it may persist for months or even throughout the entire course of treatment.[9] Some patients may experience chronic pain even after the immunotherapy has ended.[10] The intensity and duration of pain can depend on the type of immunotherapy, the patient’s response to treatment, and how quickly any inflammatory response is managed.
How to Manage Joint and Muscle Pain Associated with Biological Therapies
Managing pain caused by immunotherapy involves a combination of home remedies, over-the-counter (OTC) medications, and, in some cases, professional pain management.
- At-Home Remedies: Applying heat or cold packs, gently exercising and stretching, and maintaining a healthy diet can help alleviate pain.
- OTC Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or acetaminophen can reduce pain and inflammation.
- Professional Pain Management: If home remedies and OTC medications are insufficient, consulting a specialist for comprehensive pain management may be necessary. In severe cases, corticosteroids or other immunosuppressive drugs might be prescribed to control inflammation.
Comprehensive Pain Management for Immunotherapy-Induced Pain
Whether you are experiencing acute, short-term pain or chronic, long-term pain as a side effect of your immunotherapy treatments, effective pain management is necessary for your continued comfort. A holistic approach to pain relief addresses the physical and emotional aspects associated with cancer treatment and chronic pain. Collaboration between oncologists, rheumatologists, and pain specialists ensures a tailored treatment plan that optimally manages symptoms while allowing patients to continue their cancer treatment. Support groups and counseling can also provide emotional support and coping strategies for patients dealing with chronic pain.
Immunotherapy offers significant benefits in the fight against cancer, but it is essential to be aware of and manage its potential side effects, including joint and muscle pain. Letting your healthcare team know about your pain levels allows for proper pain management strategies to mitigate these side effects, improving the overall quality of life while you undergo biological therapy.
Resources:
- Cleveland Clinic Staff. Immunotherapy: Cancer Treatment, CAR T-Cell Therapy, Types, Risks. Cleveland Clinic. Published October 1, 2020. Accessed July 31, 2024. Available from: https://my.clevelandclinic.org/health/treatments/11582-immunotherapy
- Katella K, Ledger J. How Immunotherapy Can Treat Cancer and Other Diseases: 8 Things to Know. Yale Medicine. Published May 10, 2024. Accessed July 31, 2024. Available from: https://www.yalemedicine.org/news/how-immunotherapy-can-treat-cancer-and-autoimmune-diseases
- Cleveland Clinic Staff. Immunotherapy: Side Effects, Risks & Benefits. Cleveland Clinic [Internet]. Published September 6, 2022. Accessed July 31, 2024. Available from: https://my.clevelandclinic.org/health/diseases/21096-immunotherapy-side-effects
- Benesova K, Lorenz HM, Leipe J, Jordan K. How I treat cancer: treatment of rheumatological side effects of immunotherapy. ESMO Open [Internet]. 2020;4:e000529. Accessed July 31, 2024. doi:https://doi.org/10.1136/esmoopen-2019-000529 Available from: https://www.esmoopen.com/article/S2059-7029(20)30112-5/fulltext
- Jeurling S, Cappelli LC. Treatment of immune checkpoint inhibitor-induced inflammatory arthritis. Current Opinion in Rheumatology [Internet]. 2020;32(3):315-320. Accessed July 31, 2024. doi:https://doi.org/10.1097/bor.0000000000000701 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212600/
- Immunotherapy Side Effects. Cancer Research Institute [Internet]. Updated November 2019. Accessed July 31, 2024. Available from: https://www.cancerresearch.org/immunotherapy-side-effects
- Creţu I, Bojincă M, Milicescu M, et al. Musculoskeletal adverse reactions after immunotherapy for cancer: A case series. Experimental and Therapeutic Medicine [Internet]. 2021;22(3). Accessed July 31, 2024. doi:https://doi.org/10.3892/etm.2021.10459 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343871/
- CAR T-cell Therapy and its side effects. American Cancer Society [Internet]. Revised March 1, 2022. Accessed July 31, 2024. Available from: https://www.cancer.org/cancer/managing-cancer/treatment-types/immunotherapy/car-t-cell1.html
- Curran A. Arthritis from Cancer Immunotherapy Can Persist Even After Stopping Immunotherapy. Johns Hopkins Rheumatology [Internet]. Published January 24, 2020. Accessed July 31, 2024. Available from: https://www.hopkinsrheumatology.org/2020/01/arthritis-from-cancer-immunotherapy-can-persist-even-after-stopping-immunotherapy
- Braaten TJ, Brahmer JR, Forde PM, et al. Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation. Annals of the Rheumatic Diseases [Internet]. 2019;79(3):332-338. Accessed July 31, 2024. doi:https://doi.org/10.1136/annrheumdis-2019-216109 Available from: https://pubmed.ncbi.nlm.nih.gov/31540935/
