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Immune checkpoint inhibitor-induced joint involvement.

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Immune checkpoint inhibitors (ICI) can cause rheumatologic immune-related adverse events (irAEs), like inflammatory arthritis and polymyalgia rheumatica. Management balances symptom control with cancer treatment, often avoiding ICI cessation.

Keywords:
Immune checkpoint cancer autoimmune diseasesImmune related adverse events

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Area of Science:

  • Oncology
  • Rheumatology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are increasingly used for cancer treatment.
  • Adverse events, including rheumatologic manifestations (5-10% of patients), can occur with ICI therapy.
  • Key rheumatologic irAEs include immune checkpoint-induced inflammatory arthritis (ICI-IA) and immune checkpoint-induced polymyalgia rheumatica (ICI-PMR).

Purpose of the Study:

  • To review the characteristics and management of rheumatologic immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs).
  • To highlight the challenges in balancing arthritis control with cancer treatment efficacy.
  • To emphasize the importance of multidisciplinary management.

Main Methods:

  • Literature review of rheumatologic irAEs in patients treated with ICIs.
  • Analysis of clinical presentation, diagnostic features, and treatment strategies for ICI-IA and ICI-PMR.
  • Discussion of management principles, including corticosteroids, methotrexate, and biologic therapies.

Main Results:

  • ICI-IA often mimics rheumatoid arthritis but is typically immuno-negative and may persist after ICI cessation.
  • ICI-PMR is generally reversible.
  • First-line treatment involves low-dose corticosteroids; second-line options include methotrexate and biologics (anti-IL6, TNFi) for corticoid-dependent cases.
  • Management requires careful consideration of cancer progression risks.

Conclusions:

  • Managing rheumatologic irAEs necessitates a balance between controlling inflammatory symptoms and maintaining ICI efficacy.
  • Avoiding ICI cessation is preferred; immunomodulatory therapies should be used cautiously.
  • Collaborative care involving patients, oncologists, and rheumatologists is crucial for optimal outcomes.