与免疫检查点抑制剂发生的类风湿性免疫相关不良事件的实际管理:叙述性综述
Alice Tison1, Thomas Escoda2, Marie Kostine3
1Rheumatology Department, CHU de Brest, Brest, France; LBAI UMR1227, University of Brest, Inserm, Brest, France.
Joint bone spine
|July 3, 2025
概括
免疫检查点抑制剂 (ICI) 可以引起类风湿的副作用,如炎症性关节炎. 本指南有助于医生管理这些与免疫相关的不良事件 (irAEs) 以及它们对癌症治疗的影响.
科学领域:
- 瘤风湿病学 瘤风湿病学
- 免疫学 免疫学 免疫学
- 癌症治疗方法 癌症治疗方法
背景情况:
- 免疫检查点抑制剂 (ICI) 正在彻底改变癌症护理,但会增加与免疫相关的不良事件 (irAEs).
- 包括炎症性关节炎和肌肉炎在内的类风湿性IRAE越来越多地得到认可,并可能影响生活质量.
- 由于有限的数据和对免疫抑制影响癌症反应的担忧,对风湿性irAEs的管理具有挑战性.
研究的目的:
- 为管理ICI相关的炎症性类风湿性疾病提供实用指南.
- 在日常临床实践中协助风湿病学家和瘤学家.
- 在自身免疫性疾病患者中从ICI启动到ICI在irAEs后再挑战的管理.
主要方法:
- 关于类风湿性IRAE的当前文献和专家意见的审查.
- 为临床医生制定实用的管理策略.
- 讨论特定的风湿性irAE表型及其管理.
主要成果:
- 类风湿性IRAE涵盖了一系列疾病,从炎症性关节炎到肌炎和Sicca综合征.
- 目前使用的是基于专家的管理,反映了经典的类风湿性疾病.
- 这些指导方针涉及先前存在的自身免疫性疾病,新发病的irAEs,以及ICI重新挑战方面的考虑.
结论:
- 需要标准化指导方针来有效管理ICI相关的风湿性毒性.
- 仔细考虑免疫抑制疗法对于平衡irAE管理和癌症治疗疗效至关重要.
- 这篇文章为优化瘤风湿病学患者护理提供了实用建议.
相关概念视频
01:21Rheumatic Heart Disease III: Medical Management
36
Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
36
01:20Rheumatic Heart Disease IV: Nursing Management
41
AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
41
01:14Myocarditis III: Medical Management
17
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
17
01:17Pericarditis III: Medical Management
28
The primary objectives of managing pericarditis are to determine the underlying cause, provide effective therapy for treatment and symptom relief, and promptly detect signs and symptoms of cardiac tamponade. The following outlines the essential aspects of medical management for pericarditis:ObjectivesDetermine the Cause: Identifying the underlying cause of pericarditis is crucial for targeted treatment. Causes include viral infections, autoimmune diseases, post-cardiac injury syndrome, and...
28
01:22Myocarditis IV: Nursing Management
36
Myocarditis is an inflammatory condition of the myocardium requiring meticulous nursing management for optimal patient outcomes. Effective management begins with a thorough assessment of the patient's medical history, paying close attention to past infections, autoimmune disorders, travel history, and exposure to toxins or drugs. Recent viral infections and systemic diseases are particularly relevant due to their potential role in triggering myocarditis.Physical Examination and MonitoringThe...
36
01:25Pericarditis IV: Nursing Management
58
Pericarditis, an inflammation of the pericardium, necessitates diligent nursing management to ensure effective patient care and recovery. The initial step in managing pericarditis is a comprehensive patient medical assessment.The patient reports chest pain aggravated by breathing, coughing, and swallowing, which worsens when lying supine. The pain often improves when sitting up and leaning forward. Additional symptoms may include fever, malaise, and, in severe cases, signs of heart failure.
58