An MRI study of immune checkpoint inhibitor–induced musculoskeletal manifestations myofasciitis is the prominent imaging finding

Daoussis, Dimitrios; Kraniotis, Pantelis; Filippopoulou, Alexandra; Argiriadi, Rafaella; Theodoraki, Spyridoula; Makatsoris, Thomas; Koutras, Angelos; Kehagias, Ioannis; Papachristou, Dionysios J.; Solomou, Aikaterini; Kalofonos, Haralabos; Liossis, Stamatis–Nick C.

doi:10.1093/rheumatology/kez361

Cited by 25 publications

(19 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Electrophysiological studies revealed myopathic pattern in all cases. The majority of patients had an increase in creatine phosphokinase (CPK) and other muscle enzymes, but we should underscore the fact that several reports of ICI-induced myopathy with normal muscle enzymes exist [10,41]. Antibodies associated with myositis and myasthenia gravis were negative in most cases.…”

Section: Myositismentioning

confidence: 97%

“…Terminology and heterogeneity issues exist, making estimation of true prevalence difficult. Data from three prospective studies addressing musculoskeletal complications in ICI-treated patients [10][11][12] report inflammatory arthritis in approximately 2%-3% of the cases. In these studies, clinical presentation included not only a rheumatoid arthritis (RA)-like pattern with symmetrical polyarthritis involving wrists and hands, but also cases of oligoarthritis of the lower limbs and cases of psoriatic arthritis.…”

Section: Inflammatory Arthritismentioning

confidence: 99%

“…Magnetic resonance imaging (MRI), has also been used to evaluate ICI-induced arthritis. In our department [10], we performed the first prospective study to systemically report MRI data concerning ICI-induced musculoskeletal manifestations. Three distinct clinical patterns were evident: prominent joint involvement, prominent periarticular involvement and myo-fasciitis.…”

Section: Inflammatory Arthritismentioning

confidence: 99%

“…The differentiation between paraneoplastic and ICI-induced myositis can be sometimes difficult [35]. Prospective studies [10][11][12] report only few cases of ICI-induced myositis, indicating a low prevalence of this condition. The occurrence of ICI-induced myositis, however, seems to rise, probably along with the increase in the number of patients treated with ICIs worldwide.…”

Section: Myositismentioning

confidence: 99%

“…MRI is a useful imaging tool, especially in aiding cardiac evaluation and identifying muscle sites affected for a forthcoming muscle biopsy [39]. It is interesting that MRI data from two studies [10,12] report findings of increased signal intensity in both muscle and fascia in patients with myalgia of the lower limbs, thus characterizing a distinct, possibly milder, clinical phenotype [46].…”

Section: Myositismentioning

confidence: 99%

See 4 more Smart Citations

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Μελισσαρόπουλος

Klavdianou

Filippopoulou

et al. 2020

IJMS

Self Cite

View full text Add to dashboard Cite

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that activate the immune system, aiming at enhancing antitumor immunity. Their clinical efficacy is well-documented, but the side effects associated with their use are still under investigation. These drugs cause several immune-related adverse events (ir-AEs), some of which stand within the field of rheumatology. Herein, we present a literature review performed in an effort to evaluate all publicly available clinical data regarding rheumatic manifestations associated with ICIs. The most common musculoskeletal ir-AEs are inflammatory arthritis, polymyalgia rheumatica and myositis. Non-musculoskeletal rheumatic manifestations are less frequent, with the most prominent being sicca, vasculitides and sarcoidosis. Cases of systemic lupus erythematosus or scleroderma are extremely rare. The majority of musculoskeletal ir-AEs are of mild/moderate severity and can be managed with steroids with no need for ICI discontinuation. In severe cases, more intense immunosuppressive therapy and permanent ICI discontinuation may be employed. Oncologists should periodically screen patients receiving ICIs for new-onset inflammatory musculoskeletal complaints and seek a rheumatology consultation in cases of persisting symptoms.

show abstract

Section: Myositismentioning

confidence: 97%

Section: Inflammatory Arthritismentioning

confidence: 99%

Section: Inflammatory Arthritismentioning

confidence: 99%

Section: Myositismentioning

confidence: 99%

Section: Myositismentioning

confidence: 99%

See 3 more Smart Citations

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Μελισσαρόπουλος

Klavdianou

Filippopoulou

et al. 2020

IJMS

Self Cite

View full text Add to dashboard Cite

show abstract

Expert Perspective: Immune Checkpoint Inhibitors and Rheumatologic Complications

Cappelli

Bingham

2021

Arthritis & Rheumatology

View full text Add to dashboard Cite

Rheumatologists increasingly receive consults for patients treated with immune checkpoint inhibitors (ICIs) for cancer. ICIs can cause inflammatory syndromes known as immune-related adverse events (IRAEs). Several rheumatic IRAEs have been reported, including inflammatory arthritis, polymyalgia rheumatica, and myositis. For patients who present with musculoskeletal symptoms while receiving ICI therapy, it is important to have an algorithm for evaluation. The differential diagnosis includes a range of musculoskeletal syndromes, such as crystalline arthritis, mechanical issues, and osteoarthritis, in addition to IRAEs. After diagnosing a rheumatic IRAE, rheumatologists must work with the patient and the oncologist to form a treatment plan. Treatment of IRAEs is guided by severity. Evidence for management is limited to observational studies. Inflammatory arthritis and polymyalgia rheumatica are treated with nonsteroidal antiinflammatory drugs in mild cases, glucocorticoids for moderate-to-severe cases, and sometimes require other disease-modifying antirheumatic drugs. Myositis due to ICIs can be accompanied by myocarditis or myasthenia gravis. Glucocorticoids and withholding the ICI are usually required to treat myositis; some patients with severe myositis require intravenous immunoglobulin or plasmapheresis. Further research is needed to optimize treatment of IRAEs that does not compromise the antitumor effect of ICIs. Clinical challenge You receive a consult from a local oncologist. A 65-yearold man with a history of knee osteoarthritis (OA) who had previously undergone total joint arthroplasty of the left knee and is being treated with nivolumab (anti-programmed death 1 [anti-PD-1] monoclonal antibody) for non-small cell lung cancer has new symptoms of severe aching in his arms and legs, with limited mobility. The oncologist does not localize symptoms to the joints and/or muscles but notes that the patient is having trouble doing chores around the house such as cleaning and cooking.

show abstract

Noninvasive, longitudinal imaging-based analysis of body adipose tissue and water composition in a melanoma mouse model and in immune checkpoint inhibitor-treated metastatic melanoma patients

Thaiss

Gatidis

Sartorius

et al. 2020

Cancer Immunol Immunother

View full text Add to dashboard Cite

Background As cancer cachexia (CC) is associated with cancer progression, early identification would be beneficial. The aim of this study was to establish a workflow for automated MRI-based segmentation of visceral (VAT) and subcutaneous adipose tissue (SCAT) and lean tissue water (LTW) in a B16 melanoma animal model, monitor diseases progression and transfer the protocol to human melanoma patients for therapy assessment. Methods For in vivo monitoring of CC B16 melanoma-bearing and healthy mice underwent longitudinal three-point DIXON MRI (days 3, 12, 17 after subcutaneous tumor inoculation). In a prospective clinical study, 18 metastatic melanoma patients underwent MRI before, 2 and 12 weeks after onset of checkpoint inhibitor therapy (CIT; n = 16). We employed an in-house MATLAB script for automated whole-body segmentation for detection of VAT, SCAT and LTW. Results B16 mice exhibited a CC phenotype and developed a reduced VAT volume compared to baseline (B16 − 249.8 µl, − 25%; controls + 85.3 µl, + 10%, p = 0.003) and to healthy controls. LTW was increased in controls compared to melanoma mice. Five melanoma patients responded to CIT, 7 progressed, and 6 displayed a mixed response. Responding patients exhibited a very limited variability in VAT and SCAT in contrast to others. Interestingly, the LTW was decreased in CIT responding patients (− 3.02% ± 2.67%; p = 0.0034) but increased in patients with progressive disease (+ 1.97% ± 2.19%) and mixed response (+ 4.59% ± 3.71%). Conclusion MRI-based segmentation of fat and water contents adds essential additional information for monitoring the development of CC in mice and metastatic melanoma patients during CIT or other treatment approaches.

show abstract

An MRI study of immune checkpoint inhibitor–induced musculoskeletal manifestations myofasciitis is the prominent imaging finding

Cited by 25 publications

References 23 publications

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Expert Perspective: Immune Checkpoint Inhibitors and Rheumatologic Complications

Noninvasive, longitudinal imaging-based analysis of body adipose tissue and water composition in a melanoma mouse model and in immune checkpoint inhibitor-treated metastatic melanoma patients

Contact Info

Product

Resources

About