ABS0470 POST INTRAVESICAL BCG REACTIVE ARTHRITIS: CLINICAL FEATURES AND OUTCOMES
Bibliographic record
Abstract
Background: Reactive arthritis (ReA) manifests following genitourinary or gastrointestinal infections. The triggers of ReA include genitourinary pathogens and gastrointestinal pathogens. Other potential triggers include Bacillus Calmette-Guerin (BCG). Intravesical BCG (iBCG) is an effective treatment for some forms of urothelial cancers. The treatment protocol consists of weekly doses for 6 doses followed by monthly doses for a year. ReA following iBCG therapy is very rare and has been reported in about 0.5%-1% of bladder cancer patients treated with iBCG. Objectives: To describe the clinical profile of patients of Reactive arthritis associated with intravesical BCG. Methods: This is a multicenter retrospective case series and includes data from 10 rheumatology centers. All rheumatologists in India were contacted over email, messaging services to know their experience regarding iBCG Re A. Data was collected from individuals who had seen such cases and were willing to be part of this collaborative work. Results: There were 12 cases and 8 were males. The median age was 66 years (Range: 45-81 years). Median duration of symptoms at presentation was 22.5 days. Average time between ReA and the last dose of iBCG was 14.58 days (Median: 14 days, Range: 3-30 days). ReA occurred after the weekly dose in 9 and after the monthly dose in 3. Table 1 shows details about their presentation, treatment and outcome. None of the patients had a previous history of Tuberculosis. Table 2 elaborates the joint distribution and their frequency. Dactylitis was observed in 2 patients. Peripheral joint involvement was asymmetrical in the majority of the cases (N=7). Oligoarthritis was seen in 7 cases and polyarthritis in 5 cases. Lower limb involvement was more common. Knee was the most commonly affected joint (91.67%) followed by ankle (75%).Extra-articular manifestations were observed in 6. Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) were elevated in eight and all the twelve cases respectively. 11 patients received NSAIDS and in one patient it was deferred because of borderline increased serum creatinine. The median follow up duration was 48 months. Other treatment and outcome details as per Table 2. Conclusion: Rheumatic complications like ReA are rare and an early complication of iBCG therapy. It is more common after the weekly dose rather than the monthly dose. Asymmetrical oligoarthritis of the large joints of the lower limb joints is the frequent clinical pattern. Discontinuation of iBCG is important. NSAIDs, glucocorticoids are required for most of them. Some may require Disease modifying anti-rheumatic drugs. Outcome is good with most having controlled disease at last follow up. REFERENCES: NIL . Table 1Intravesical BCG Reactive arthritis: Patient characteristics, articular symptom details, treatment and outcome.NoAge/ GenderSymptom duration(days)Time interval (days)*HLAB27TreatmentOutcome167/ M607+veiBCG stoppedGC (oral); SSZActive arthritis267/ M1014-veiBCG continuedGC (IM)Controlled arthritis362/ M714+veiBCG stoppedGC (IM, IA, oral); MTX, SSZControlled arthritis465/ M730-veiBCG stoppedGC (IA, oral);SSZControlled arthritis545/ F3015-veiBCG stoppedGC (IM, oral);SSZControlled arthritis660/ M153+veiBCG continuedGC (oral);MTX, SSZControlled arthritis769/ F3015NDiBCG continuedGC (IA);HCQsControlled arthritis870/ F23-veiBCG stoppedSSZControlled arthritis946/ F157+veiBCG stoppedGC (oral); MTX, SSZControlled arthritis1045/ M607NDiBCG stoppedHCQControlled arthritis1178/ M3030+veiBCG stoppedGC (IM), SSZControlled arthritis1281/ M3030NDiBCG stoppedGC (oral); HCQControlled arthritisM- male, F- Female, EAMs - Extra-articular manifestations, ND - Not done; NSAIDs- Non Steroidal Anti Inflammatory Drugs, GC- Glucocorticoids, IM - Intramuscular, IA- Intra-articular, SSZ- Sulfasalazine, MTX- Methotrexate, HCQs- Hydroxychloroquine, iBCG - Intravesical BCG, * interval between Re A onset and last dose of iBCG in days Table 2Frequency and distribution of articular manifestations.Articular involvementFrequency (N/11) (%)Enthesitis4/12 (33.33%)Bursitis1/12 (8.33%)Inflammatory Back Pain2/12 (16.67%)Dactylitis2/12 (16.67%)Peripheral arthritisShoulder4/12 (33.33%)Elbow3/12 (25%)Wrist5/12 (41.67%)MCP4/12 (33.33%)PIP5/12 (41.67%)DIP2/12 (16.67%)Hip1/12 (8.33%)Knee11/12 (91.67%)Ankle9/12 (75%)Midfoot2/12 (16.67%)MTP2/12 (16.67%) Acknowledgements: NIL . Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".