Rheumatoid arthritis and polymyalgia rheumatica occurring after immune checkpoint inhibitor treatment

Abstract

This is the first description of RA occurring after ICI therapy for cancer. PMR can also occur after ICI, particularly after anti-PD-1 therapy. All cases responded to corticosteroids or with immunosuppressive therapy. Collaboration between rheumatologists and oncologists is crucial and could lead to better recognition and care of these patients.

Rheumatic disorders associated with immune checkpoint inhibitors in patients with cancer—clinical aspects and relationship with tumour response: a single-centre prospective cohort study

“…When needed, methotrexate was added, which was the case for two patients. In our experience, as in the series reported by Belkhir et al ,16 classical anti-inflammatory treatment was able to control rheumatic disorders without any modification of the ICI regimen, conversely to the experience of American colleagues, who reported a requirement for higher steroid dosage (often >40 mg/day), the use of tumour necrosis factor inhibitors for some patients and usually ICI discontinuation 14 15. Furthermore, the increasing number of cases reported in the literature illustrates these differences regarding rheumatic irAE management, highlighting the need for developing either national or international recommendations.…”

The evolving role of the rheumatologist in the management of immune-related adverse events (irAEs) caused by cancer immunotherapy

“…While the early clinical series3 18 of rheumatic irAEs failed to demonstrate the presence of autoantibodies in patients with inflammatory polyarthritis, several recent reports suggest that pre-existing autoantibodies such as anticitrullinated protein antibodies5 and diabetes-associated islet antibodies19 may be predictive of new-onset rheumatoid arthritis and type 1 diabetes. Thus, efforts to profile risk for incident irAEs prior to checkpoint therapy need to be explored and specialists such as rheumatologists may be logical partners to monitor and manage such complications before they occur.…”

Polymyalgia rheumatica development in a patient under PI3K inhibitor therapy for chronic lymphocytic leukaemia

“…Recent studies have shown that immune checkpoint inhibitors which are immunostimulatory in nature are associated with PMR development which was reported in four cases and where PMR responded to standard therapy 29. Off note, the most severe toxicity in the checkpoint inhibitor class of drugs including anti-CTLA-4 and anti-programmed cell death protein 1 (PD-1) and anti-PD-L1 is gut toxicity and this is more common with anti-CTLA-4 30.…”