Optimizing management of immune checkpoint inhibitor-induced inflammatory arthritis: A case series and literature...

Immune checkpoint inhibitors (ICIs) are widely applied in the treatment of various malignant tumors, leading to notable improvements in patient prognosis. However, with their increased use, various immune-related adverse events (irAEs), including ICI-induced inflammatory arthritis (ICI-IA), may develop, affecting clinical evaluation and treatment decisions. The present report presents 3 cases of ICI-IA and reviews the literature on its clinical features, diagnosis and therapeutic approaches. The first patient, who had been diagnosed with metastatic bladder cancer, developed limb joint pain after undergoing combination therapy involving ICIs and chemotherapy. Laboratory tests showed elevated levels of C-reactive protein and interleukin (IL)-6. Bone scintigraphy excluded bone metastasis, and the symptoms of the patient improved following corticosteroid therapy. The second patient had advanced cervical cancer and a history of rheumatoid arthritis. Following multiple cycles of ICI combined with anti-angiogenic treatment, the patient experienced recurrent joint swelling and pain, accompanied by elevated IL-6 and IL-10 levels. Bone scintigraphy excluded bone metastasis, and the symptoms were controlled with corticosteroid therapy. The third patient had advanced lung cancer and developed persistent pain in the shoulders, knees and ankles during immunotherapy. Corticosteroid therapy effectively controlled the symptoms after bone metastases and autoimmune diseases were excluded. These cases illustrate that ICI-IA is a clinically relevant irAE. Early recognition and management are crucial for improving patient prognosis. A thorough understanding of the pathogenesis of ICI-IA is essential for optimizing treatment strategies and improving quality of life.