Bee venom pharmacopuncture for symptom relief in rheumatoid arthritis in a tamoxifen-treated breast cancer survivor who declined methotrexate: A case report.

BACKGROUND

The concurrent presentation of rheumatoid arthritis (RA) in breast cancer survivors complicates therapeutic decision-making, particularly during long-term adjuvant tamoxifen therapy. In this setting, escalation to standard immunosuppressive disease-modifying antirheumatic drugs (DMARDs) may be delayed or declined because of concerns regarding cancer survivorship, polypharmacy, and treatment-related toxicity.

CASE PRESENTATION: A postmenopausal Korean woman receiving tamoxifen 20 mg/day for right-breast ductal carcinoma in situ (pTisN0) developed symmetric polyarthritis involving the hands, wrists, and feet and met the 2010 ACR/EULAR classification criteria for RA (score 10/10). Methotrexate was recommended, but the patient repeatedly and voluntarily declined the medication due to profound concerns over adverse drug events.

INTERVENTION: Over approximately 9 months, she received 36 sessions of bee venom pharmacopuncture administered to symptomatic peripheral joints with stepwise dose titration, combined with electroacupuncture. Hydroxychloroquine, low-dose methylprednisolone, and as-needed nonsteroidal anti-inflammatory drugs were continued. No additional immunosuppressive DMARD was initiated.

OUTCOMES: Pain intensity decreased from 9.5 to 2.5 on the numerical rating scale, morning stiffness resolved, and daily functioning improved. DAS28-ESR improved from 5.68 to 4.85 but remained in the moderate disease activity range, and inflammatory markers did not normalize. No serious adverse events were observed.

CONCLUSIONS

Integrative care centered on bee venom pharmacopuncture was associated with clinically meaningful symptom relief, although persistent inflammatory activity warrants cautious interpretation.