Chemotherapy when you have an autoimmune condition

Usually, yes. Autoimmune conditions, where the immune system attacks the body's own tissues, include rheumatoid arthritis, lupus, psoriasis and psoriatic arthritis, inflammatory bowel disease, multiple sclerosis, vasculitis and autoimmune thyroid disease. Having one of these does not normally prevent chemotherapy. The main issues are medicines and infection. Many people with autoimmune conditions take medicines that calm the immune system, such as methotrexate, azathioprine, mycophenolate, leflunomide, steroids like prednisolone, or biological injections such as adalimumab, infliximab or etanercept. Combined with chemotherapy, these can raise the risk of infection, and some, like methotrexate, can add to side effects on the blood and liver.

Your rheumatologist, gastroenterologist, dermatologist or neurologist and your oncologist need to agree a plan. Some immune-calming medicines may be paused during chemotherapy, especially those that strongly affect immunity or interact with cancer medicines. Others, such as hydroxychloroquine, are often continued. Chemotherapy itself calms the immune system, so some autoimmune conditions quieten during treatment, while others flare when usual medicines are paused. Steroids must never be stopped suddenly, because long-term use means the body needs time to restart its own steroid production; stopping abruptly can cause dangerous weakness and low blood pressure. All changes should be made only by your doctors.

Before treatment, screening for hepatitis B and tuberculosis is especially important, because both immune-calming medicines and chemotherapy can cause hidden infections to flare. Vaccinations such as flu and pneumonia vaccines are ideally given before chemotherapy starts, while live vaccines are generally avoided. Your team will also consider organ effects of your condition, such as kidney involvement in lupus or lung involvement in rheumatoid arthritis, when choosing medicines.

Bring a full medicine list

Include tablets, injections, infusions and steroid courses, with dates of recent doses.

Never stop steroids suddenly

Ask your doctor how steroids will be managed, including during illness.

Tell your specialist about cancer

Ask your autoimmune specialist and oncologist to communicate directly.

It cannot tell you which of your medicines should continue, pause or change. That depends on your condition, how active it is, the medicines involved and the cancer treatment planned, and must be decided by your specialists together.

It also cannot predict whether your condition will flare or settle during chemotherapy. Experiences vary widely.

Immune checkpoint treatments

Immune treatments that release the brakes on the immune system, used for melanoma, lung, kidney and other cancers, can trigger flares of existing autoimmune conditions or new immune side effects. People with autoimmune conditions can sometimes still receive them, especially if the condition is mild and well controlled, but they need careful discussion and close monitoring by both teams.

Steroid cover during illness

People on long-term steroids may need extra steroid cover during severe illness, surgery or vomiting. Ask your doctor for a steroid plan and carry a steroid card if advised.

Restarting medicines after chemotherapy

Paused autoimmune medicines are usually restarted once chemotherapy ends and blood counts recover, as decided by your specialist. Some biological medicines may need extra consideration after certain cancers.

Mouth ulcers, rashes and bowel symptoms

Chemotherapy side effects can resemble autoimmune symptoms. Keep a symptom diary and share it with both teams.

Emotional and practical load

Managing two long-term conditions is tiring. Ask about counselling and practical support.

Vaccinations for household members

Family members can help protect you by staying up to date with vaccines such as flu vaccine.

Inflammatory bowel disease and chemotherapy

People with Crohn's disease or ulcerative colitis may find it hard to tell chemotherapy diarrhoea from a flare. Both need prompt attention, especially with fever or blood in stools. Your gastroenterologist and oncologist may test stools for infection and check inflammation markers before deciding on treatment. Some cancer medicines that commonly cause diarrhoea may need extra care.

Lupus and kidney or blood involvement

Lupus can affect kidneys and blood counts. Your team will check kidney function and blood counts before choosing medicines, and may involve a kidney specialist. Lupus flares can sometimes resemble infection, so fever always needs assessment.

Psoriasis and skin care

Some cancer medicines cause rashes or dry skin that can resemble psoriasis flares. Gentle moisturisers and a dermatologist's advice help, and creams are usually simpler to continue than tablets or injections that affect immunity.

Multiple sclerosis

People with multiple sclerosis often take disease-modifying medicines that affect immunity. These need careful review with a neurologist before chemotherapy, and some may need a gap before cancer treatment starts.

Thyroid conditions

Autoimmune thyroid disease is common and usually continues to be managed with thyroid tablets. Some immune treatments for cancer can also affect the thyroid, so thyroid tests may be checked.

Keeping a flare plan

Ask your autoimmune specialist for a plan explaining what to do and whom to call if symptoms flare during cancer treatment.

Pain relief choices

Anti-inflammatory painkillers commonly used for joint pain can affect kidneys and bleeding when platelets are low. Ask which pain relief is safest during chemotherapy.

Keeping your specialists informed

Send copies of your oncology letters to your autoimmune specialist so they know about each change in treatment.

What to do next

Bring a complete medicine list, ask your specialists to agree a plan, never stop steroids suddenly, have hepatitis B and TB screening, get recommended vaccines before treatment, report flares and infections early, and discuss immune treatments carefully if offered.