4 years ago

Arthritis after cancer immunotherapy: symptom duration and treatment response

Anne R. Bass, Melanie H. Smith
Objective Musculoskeletal manifestations of immune related adverse events (irAEs) after checkpoint inhibitor immunotherapy for cancer remain incompletely characterized and poorly understood. A recently published case series suggested that immunotherapy-induced arthritis is an aggressive process requiring high dose corticosteroids. Methods This was a retrospective chart review of all patients with musculoskeletal irAEs first seen by one of the authors between 2014 and 2016. All patients had been treated for a malignancy with immune checkpoint inhibitors targeting PD-1 (nivolumab, pembrolizumab), PD-L1 (durvalumab) and/or CTLA-4 (ipilimumab, tremelimumab) at Memorial Sloan Kettering Cancer Center. Results We identified 10 patients with a mean (± standard deviation) age 63.2 (± 9.7) years. Seven were treated with a combination of checkpoint inhibitors and three with nivolumab monotherapy. Four developed inflammatory polyarthritis, four oligoarthritis and two tenosynovitis. Six were ANA positive and two had anti-CCP antibodies. Mean time from the first dose of immunotherapy until joint involvement was 6.3 (± 4.3) months. All 10 patients were treated with systemic corticosteroids, but 6/10 required ≤ 20 mg per day of prednisone. Five patients received steroid-sparing agents. Mean time until resolution of joint symptoms after the last dose of immunotherapy was 9.2 (± 6.1) months. Conclusion Musculoskeletal irAEs can manifest as an RA-like polyarthritis, oligoarthritis, tenosynovitis, or PMR. Musculoskeletal symptoms can last more than a year, but they can generally be managed with low to moderate doses of corticosteroids. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/acr.23467

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