Aim To investigate whether any patient or treatment characteristics are associated with the development of rheumatic immune‐related adverse events (irAEs) following programmed cell death protein 1 (PD‐1) inhibitor therapy for cancer. Method This was a retrospective chart review of all patients who were dispensed nivolumab or pembrolizumab at a single center before 1 January, 2017, with follow‐up until 1 July, 2017. Patients with any diagnosis of a non‐cutaneous irAE were identified, regardless of severity, and rheumatic irAEs were characterized. Results Of 244 episodes of therapy, a non‐cutaneous irAE occurred in 72 (29.5%). Rheumatic irAEs were diagnosed in 19 episodes of therapy (7.8%), with 12 de novo diagnoses (5.1% of episodes without a pre‐existing autoimmune rheumatic disease) and 7 exacerbations of existing disease. Review by a rheumatologist occurred in only 11 of these. Rheumatic irAEs were more common in patients with a good oncological response to therapy (relative risk [RR] 11.16), those being treated for melanoma (RR 2.94) and those who developed another non‐cutaneous irAE (RR 2.64). Conclusion Rheumatic irAEs are relatively common with PD‐1 inhibitor therapy, and appear to be associated with a good oncological response to therapy. Many rheumatic irAEs were not referred to rheumatological services. Prospective systematic investigation would be of benefit to explore these characteristics.

No abstract

Objective: To assess the intrarater and interrater reliability among rheumatologists of a standardised protocol for measurement of shoulder movements using a gravity inclinometer. Methods: After instruction, six rheumatologists independently assessed eight movements of the shoulder, including total and glenohumeral flexion, total and glenohumeral abduction, external rotation in neutral and in abduction, internal rotation in abduction and hand behind back, in random order in six patients with shoulder pain and stiffness according to a 6×6 Latin square design using a standardised protocol. These assessments were then repeated. Analysis of variance was used to partition total variability into components of variance in order to calculate intraclass correlation coefficients (ICCs). Results: The intrarater and interrater reliability of different shoulder movements varied widely. The movement of hand behind back and total shoulder flexion yielded the highest ICC scores for both intrarater reliability (0.91 and 0.83, respectively) and interrater reliability (0.80 and 0.72, respectively). Low ICC scores were found for the movements of glenohumeral abduction, external rotation in abduction, and internal rotation in abduction (intrarater ICCs 0.35, 0.43, and 0.32, respectively), and external rotation in neutral, external rotation in abduction, and internal rotation in abduction (interrater ICCs 0.29, 0.11, and 0.06, respectively). Conclusions: The measurement of shoulder movements using a standardised protocol by rheumatologists produced variable intrarater and interrater reliability. Reasonable reliability was obtained only for the movement of hand behind back and total shoulder flexion. Shoulder pain is common in the general population, its point prevalence averages between 7% and 51% and it is known to increase with age. Restricted range of motion and shoulder pain can interfere with activities in daily life and is associated with work absenteeism and use of medical services.1-5 Many patients receive some evaluation by a family doctor, rheumatologist, orthopaedic specialist, or physical therapist. 3A physical examination is often used for both diagnosis and evaluation of treatment success in patients with shoulder pain. One aspect of physical assessment of the shoulder is the evaluation of range of motion. No "gold standard" for the measurement of shoulder range of motion is yet available. Clinical trials that have assessed the efficacy of interventions for shoulder pain have commonly used range of motion of the shoulder as a measurement tool. 6 To be of value in clinical trials or routine care its reliability (that is, the repeated administration of an instrument to a stable population yielding the same results) should be established.Multiple methods for estimating shoulder range of motion have been used in the past, including visual estimation, the two armed goniometer, or a gravity referenced goniometer. [7][8][9][10][11][12][13][14][15][16] In many of these studies the methods are poorly described and most looked at...

The clinical expression of AS in this first-described Australian cohort is similar to previously described cohorts. We observed greater cervicothoracic mobility and a higher enthesitis index among women perhaps contributing to longer delay to diagnosis.