Publication Details
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease characterized by synovial inflammation and progressive joint destruction. In patients with concomitant malignancies, chemotherapy represents a unique immunomodulatory intervention that may significantly influence RA disease activity. This narrative review aims to summarize and critically evaluate current evidence regarding chemotherapy-induced modulation of rheumatoid arthritis activity in oncology patients. Available clinical and experimental data suggest that several chemotherapeutic agents exert profound effects on immune regulation, cytokine production, and lymphocyte proliferation, mechanisms that overlap with the immunopathogenesis of RA. Conventional cytotoxic drugs such as methotrexate, cyclophosphamide, and platinum-based agents have been reported to induce partial remission or attenuation of RA symptoms in some patients, primarily through suppression of autoreactive T and B cells. Conversely, immune checkpoint inhibitors and certain targeted therapies may exacerbate RA activity or trigger immune-related adverse events resembling inflammatory arthritis. The review highlights the dual and context-dependent nature of chemotherapy on RA, influenced by cancer type, therapeutic regimen, baseline autoimmune activity, and patient-specific immunogenetic factors. Changes in inflammatory biomarkers, including tumor necrosis factor-α, interleukin-6, and C-reactive protein, are discussed as potential indicators of chemotherapy-associated shifts in RA disease activity. Additionally, the clinical challenges of differentiating chemotherapy-related arthralgia from true RA flare are addressed. Understanding the complex interaction between chemotherapeutic agents and autoimmune pathways is essential for optimizing clinical management, minimizing adverse outcomes, and improving quality of life in oncology patients with RA. Further prospective studies are warranted to establish evidence-based guidelines for integrated oncologic and rheumatologic care.