The development of inflammatory arthritis and other rheumatic diseases following stem cell transplantation.
OBJECTIVE
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.
Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada. ccbarnab@ucalgary.ca
Cheryl C M
CC
Barnabe
Sharon A
SA
LeClercq
Avril A
AA
Fitzgerald
D001168:Arthritis / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D001327:Autoimmune Diseases / Q000276:immunology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007109:Immunity / Q000276:immunology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D055815:Young Adult