title: [Arthritis following intravesical instillation of BCG for urothelial cancers].
abstract: BACKGROUND
  Intravesical instillation of bacillus Calmette-Guerin (BCG) is efficient for prophylaxis of superficial bladder cancer and treatment for carcinoma in situ (CIS) of the upper urethelial cancer. However, the incidence of adverse effects is relatively high, and those include reactive arthritis. We retrospectively evaluated the incidence and the outcome of reactive arthritis following intravesical BCG therapy for urothelial cancers.
  
  
  METHODS
  Intravesical instillations of BCC were performed in 192 cases (218 courses) between January 1998 and January 2002. BCG was instilled for prophylaxis of superficial bladder cancer recurrence in 170 (195 courses), treatment for CIS in 7 (8 course), and treatment for CIS in 7 (8 courses), and treatment for CIS in upper urinary tract in 15 (15 courses).
  
  
  RESULTS
  Arthritis was recognized in 8 cases (3.7%, 8/218 courses), and 7 of them were identical to reactive arthritis following BCG therapy. Remaining 1 patient was diagnosed as rheumatoid arthritis (RA), and the relation between arthritis and intravesical BCG instillation was unclear. Mean number of BCG instillation was 5.6 (3-8 times). All reactive arthritis were occurred within 4 weeks after the last BCG instillation, i.e., BCG induced urinary tract infection, and 6 of them were polyarthritis. Concurrence of conjunctivitis was seen in one patient. HLA-B27 was negative in 4 examined patients. A nonsteroidal anti-inflammatory drug (NSAID) was used in all 8 patients, anti-tuberculous agents were used in 3, and prednisolone was added in 3, Arthritis was improved within 2 months in patients received prednisolone, however, it persisted longer than 3 months in patients without prednisolone.
  
  
  CONCLUSIONS
  Arthritis was recognized in higher incidence than previous reports following intravesical instillation of BCG. All cases except one, diagnosed as RA, were diagnosed as reactive arthritis (Reiter's syndrome). However, correlation between HLA-B27 and arthritis was not clear in this study. Administration of steroidal drug was thought to improve arthritis in shorter duration.
authors.affiliation: Department of Urology, Yokohama General Hospital.
authors.forename: Sadanori
authors.initials: S
authors.lastname: Minei
authors.forename: Akira
authors.initials: A
authors.lastname: Irie
authors.forename: Weigiand
authors.initials: W
authors.lastname: Chen
authors.forename: Shinji
authors.initials: S
authors.lastname: Kurosaka
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tabata
authors.forename: Hideshige
authors.initials: H
authors.lastname: Koh
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ishii
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Iwamura
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Uchida
authors.forename: Satoru
authors.initials: S
authors.lastname: Shimura
authors.forename: Shiro
authors.initials: S
authors.lastname: Baba
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D001168:Arthritis / Q000209:etiology*; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D002278:Carcinoma in Situ / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery
chemical_list: D001500:BCG Vaccine