Musculoskeletal and Rheumatic Diseases Induced by Immune Checkpoint Inhibitors: A Review of the Literature

Abstract

Background: Immune checkpoint inhibitors are a new promising class of antitumor drugs that have been associated with a number of immune-related Adverse Events (AEs), including musculoskeletal and rheumatic disease.Methods: We searched Medline reviewing reports of musculoskeletal and rheumatic AEs induced by immune checkpoint inhibitors.Results: Several musculoskeletal and rheumatic AEs associated with immune checkpoint inhibitors treatment are reported in the literature. In particular, arthralgia and myalgia were the most common reported AEs, whereas the prevalence of arthritis, myositis and vasculitis is less characterized and mainly reported in case series and case reports. Other occasionally described AEs are sicca syndrome, polymyalgia rheumatica, systemic lupus erythematosus and sarcoidosis.Conclusion: Newly induced musculoskeletal and rheumatic diseases are a frequent adverse event associated with immune checkpoint inhibitors treatment

EULAR points to consider for the diagnosis and management of rheumatic immune-related adverse events due to cancer immunotherapy with checkpoint inhibitors

“…While arthralgia and myalgia were the most commonly reported rheumatic irAEs in clinical trials, numerous case series and reports have captured a broader spectrum of de novo rheumatic and systemic manifestations that can occur with cancer immunotherapy. [62][63][64] Polymyalgia rheumatica (PMR)-like syndromes and inflammatory arthritis syndromes are two of the major clinical presentations encountered. 39-41 48 65 66 PMR-like manifestation occurred with a median exposure time to CPI of 60 days, but also much later (IQR 24-210 days).…”

A Rare Side Effect of Checkpoint Inhibitor Therapy—Nivolumab‐Induced Axial Polyarthritis of the Facet and Costovertebral Joints

“…The occurrence of arthritis with checkpoint inhibitor therapy has been reported in the literature, with an incidence of up to 16% . However, a primary axial manifestation has not been described to date . This case adds to our knowledge of the wide range of side effects of immune checkpoint inhibitors and is the first report of checkpoint inhibitor–induced axial SpA.…”

Development of a Functional Assessment of Chronic Illness Therapy item library and primary symptom list for the assessment of patient-reported adverse events associated with immune checkpoint modulators

“…Our literature review yielded 25 articles documenting irAE incidence, management guidelines, toxicity profiles, and associated symptomatology [4,9,[11][12][13][14][15][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] . From these, we identified 75 possible inflammatory reactions/immune conditions across 11 organ systems, ranging from very common to rare.…”