Polyarthritis following intravesical BCG immunotherapy. Report of a case and review of 26 cases in the literature.

ABSTRACT

OBJECTIVE: To delineate the characteristics of aseptic arthritis induced by intravesical BCG immunotherapy. METHODS: Review of a personal case and 26 cases from the literature. RESULTS: Mean number of intravesical BCG instillations at arthritis onset was five. Arthritis onset was within two weeks of the last instillation in 90% of cases. Half the patients had fever and half had conjunctivitis or uveitis. Symmetric polyarthritis was the most common pattern (n = 19), followed by oligoarthritis (n = 7). One patient had monoarthritis. The main targets were the knees (81%), ankles (48%), and wrists (40%). Twenty-six percent of patients reported back pain and 11% had sacroiliitis manifesting as pain or radiological changes. Mean erythrocyte sedimentation rate was 89 mm/h and mean C-reactive protein was greater than 70 mg/l. HLA B27 was positive in 56% of cases. Joint fluid usually exhibited inflammatory properties with polymorphonuclear neutrophils as the predominant cell type. Synovial membrane biopsy showed nonspecific synovitis in the six patients who had this investigation. Nonsteroidal antiinflammatory therapy was effective in 75% of cases. Three of the six patients given isoniazid and/or rifampin responded to this treatment. CONCLUSION: Although arthritis induced by intravesical BCG immunotherapy is more often polyarticular than oligoarticular, it shares many features with reactive arthritis.