AB1423 INTRAVESICAL BCG ASSOCIATED REACTIVE ARTHRITIS: A SURVEY OF RHEUMATOLOGIST ABOUT ITS AWARENESS AND OPINION REGARDING APPROPRIATE TREATMENT
Authors: Y. Singh, Y. G C, S. Prasad, A. Joshi
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Intravesical BCG therapy (iBCG) is considered an effective mode of immunotherapy for superficial bladder cancer. Rarely, it can be associated with musculoskeletal adverse effects like reactive arthritis (Re A). It is observed in less than 5% of patients. It is usually an early complication, and most cases occur within 6 doses of iBCG.The outcome is variable. Most of the cases resolve on withdrawal of iBCG and continuing iBCG usually worsens the Re A. Some even recommend anti-tuberculosis treatment (ATT) as a treatment option. Most experts recommend stopping iBCG and planning other treatment options for the bladder cancer. <h3>Objectives:</h3> To assess the awareness about iBCG related Re A, perception about its treatment and opinion about role of ATT among Rheumatologists in India. <h3>Methods:</h3> An online survey of Rheumatologists was conducted using Google forms over a period of 3 months from 1st October 2023 to 31st December 2023. The questionnaire included a cover letter and contained questions about demographic details, location of practice (rural versus urban), professional experience, research involvement, predominant practice type (teaching hospital versus non-teaching), awareness about iBCG related Re.A. A clinical scenario of iBCG related Re A was included and the purpose was to understand the opinion regarding its appropriate management. The final question was to understand the opinion regarding ATT as a treatment for iBCG related Re A. Statistical analysis included descriptive frequencies and comparison between groups using chi square test. <h3>Results:</h3> There were totally 502 responses and 8 didnot consent for the survey. The analysis was done on 494 responses who had consented. Majority of the respondents were aware about iBCG related Re A - 341 (69.02 %). Demographic details are as per Table 1. About 390 (78.94 %) respondents had never encountered a case of iBCG related Re A till now, 98 (19.83 %) had seen &lt; 5 cases, 6 (1.21 %) had seen between 6 to 10 cases. Treatment of iBCG Re A - 216 (43.72 %) felt that the further treatment with iBCG needs to stopped, 121 (24.49 %) felt that iBCG can be continued and Re A needs to be managed symptomatically and 157 (31.78 %) were not sure of the appropriate treatment (Figure 1). Nearly 50 % of the respondents opined that there was no role of ATT [N=245 (49.59 %)], whereas 61 (12.34 %) felt that ATT has a role and 188 (38.05 %) were not sure about the exact role of ATT (Figure 1). The responses were compared based gender, age, place of practice, predominant practice type and researc involvement. There was no difference in the responses based on gender, place of practice, age, professional experience, involvement in research, predominant practice. <h3>Conclusion:</h3> iBCG related Re A is a rare entity and majority of the respondents had not encountered even a single case. Though it is rare approximately 70% were aware of this entity.Approximately 45% agreed with general consensus of stopping further treatment with iBCG. But approximately 1/4th felt that despite Re A, iBCG could be continued. About 1/ 3 rd of the respondents didnot know whether iBCG needs to be stopped or continued. Nearly 50% felt that ATT has not role in treatment of iBCG related Re A. There is a need to further study the natural history and appropriate treatment of this rare condition. There is also increase awareness about this condition (especially the appropriate treatment) so that the affected patients are managed correclty. <b>REFERENCES: NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>