From the Guidelines
Mycosis fungoides and arthritis should be managed separately, with treatment coordination between dermatologists and rheumatologists to avoid drug interactions and optimize outcomes. Mycosis fungoides is a type of cutaneous T-cell lymphoma that primarily affects the skin, while arthritis refers to joint inflammation that can have various causes. There is no established causal relationship between these conditions, though some patients with mycosis fungoides may develop arthritis as a paraneoplastic syndrome or as a side effect of treatments.
Treatment of Mycosis Fungoides
For mycosis fungoides, treatments may include:
- Topical corticosteroids
- Phototherapy
- Radiation
- Systemic therapies like retinoids, interferon, or chemotherapy depending on disease stage, as recommended by the British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines 1
- Bexarotene, a novel synthetic retinoid, has been shown to promote apoptosis and inhibit cell proliferation, with response rates of 20% to 67% in phase II and III studies 1
Treatment of Arthritis
For arthritis, treatment depends on the specific type but often includes:
- NSAIDs like ibuprofen or naproxen
- Disease-modifying antirheumatic drugs
- Biologics, such as TNFi or IL-17i biologics, as recommended by the American College of Rheumatology and National Psoriasis Foundation guideline for the treatment of psoriatic arthritis 1
- Methotrexate is considered the anchor drug and should be used first in patients at risk of developing persistent disease, as recommended by the EULAR recommendations for the management of early arthritis 1
Coordination of Care
When both conditions occur together, treatment coordination between dermatologists and rheumatologists is essential to avoid drug interactions and optimize outcomes. Patients should monitor for skin changes and joint symptoms, reporting any new or worsening symptoms to their healthcare providers promptly. Regular monitoring of disease activity and adverse events should guide decisions on choice and changes in treatment strategies, as recommended by the American College of Rheumatology and National Psoriasis Foundation guideline for the treatment of psoriatic arthritis 1.
From the Research
Mycosis Fungoides and Arthritis
- Mycosis fungoides is a type of cutaneous T-cell lymphoma that can have various clinical presentations, including skin patches, plaques, and tumors 2.
- There is no direct evidence in the provided studies that links mycosis fungoides to arthritis.
- However, some studies suggest that methotrexate, a common treatment for arthritis, can also be effective in treating mycosis fungoides 3, 4, 5.
- Methotrexate has been shown to induce remission in some patients with mycosis fungoides, with response rates ranging from 33% to 70.9% 3, 4, 5.
- The effectiveness of methotrexate in treating mycosis fungoides may depend on the stage of the disease and the dose of the medication 4, 5.
- A Cochrane review of interventions for mycosis fungoides found that there is a lack of high-certainty evidence to support decision making in the treatment of the disease, but PUVA (psoralen plus ultraviolet A light) is commonly recommended as first-line treatment 6.