Although joint pain is not listed in the product information as a side effect of Dupixent (dupilumab), reports of painful joints, tendinitis, and arthritic-like pain associated with Dupixent use are starting to appear. Notable examples in the literature include:

• A 55-year-old woman with life-long AD who had been taking Dupxient for one and a half years complained of joint pain in multiple joints, especially her thumbs, for a few months
• A 38- year-old woman developed severe joint pain and morning stiffness in one ankle, within days of her first dose of Dupixent which then progressed to her knees, hips, and elbows. Other causes of arthritis were ruled out and the Dupixent was discontinued. Treatment with prednisolone and celecoxib resolved the joint pain and her AD was subsequently controlled with methotrexate
• A 40-year-old man who had been administering Dupixent for 16 weeks developed generalized joint pains and morning stiffness resulting in a progressive decline in mobility. Dupixent was discontinued and naproxen administered; however, 4 months later his mobility remained poor
• A 48-year-old man developed left thumb tenderness and bilateral Achilles tendinopathy after 6 weeks of Dupixent. He continued with Dupixent and his symptoms had partially improved 24 weeks after their onset
• A 68-year-old woman developed generalized joint pain 6 weeks after starting Dupixent. An ultrasound at 12 weeks demonstrated bilateral lateral epicondylitis (tennis elbow). Dupixent was discontinued but she still had symptoms 15 weeks after discontinuation.

How do you treat Dupixent-related joint pain?

Naproxen may be given as treatment for Dupixent-associated joint pain, followed by methotrexate if naproxen is ineffective. Consideration should be given to discontinuing Dupixent if the joint pain persists despite treatment or is particularly severe.

What causes Dupixent-related joint pain or tendinitis?

Experts aren’t sure exactly why Dupixent causes joint pain, but suspect that in certain people, by preferentially inhibiting the interleukins IL‐4 and IL‐13, Dupixent may enhance IL‐17‐mediated inflammation, particularly in the joints.

What are the side effects of Dupixent?

The most common side effects reported with Dupixent in the product information include:

• Injection site reactions (such as redness, pain, swelling at the injection site) experienced by 10% of people
• Conjunctivitis (inflammation of the conjunctiva [Linin] of the eye) which includes conjunctivitis due to allergic, bacterial, or viral causes, giant papillary conjunctivitis, eye irritation, and eye inflammation experienced by 10% of people
• Oral herpes (cold sores), experienced by 4% of people
• Other herpes simplex virus infections, experienced by 2% of people
• Itchy eyes, experienced by 1% of people
• Dry eye, experienced by less than 1% of people
• Blepharitis (inflammation along the edges of the eyelids), experienced by less than 1% of people
• Keratitis (an inflammation of the cornea), experienced by less than 1% of people.