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免疫检查点抑制剂诱导的炎症性关节炎与类风湿性关节炎:比较性综述
Iliopoulos Georgios1, Sideridou Fani1, Bogdanos Dmitrios2
1Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece.
免疫检查点抑制剂诱导的炎症性关节炎 (ICI-IA) 模仿类风湿性关节炎,但通常是血清阴性. 区分ICI-IA和RA对于癌症患者的有效治疗至关重要.
科学领域:
- 在瘤学瘤学.
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI) 彻底改变了癌症治疗,但会导致与免疫相关的不良事件 (irAEs).
- ICI诱导的炎症性关节炎 (ICI-IA) 是最常见的肌肉骨性关节炎,通常类似于类风湿性关节炎 (RA).
- 区分ICI-IA和RA对于适当的患者管理至关重要.
研究的目的:
- 在关键的临床和病理领域比较ICI-IA和RA.
- 综合当前关于流行病学,病理生理学,呈现,成像,治疗和预后的证据.
- 突出诊断和治疗方面的考虑在瘤学和风湿病学的交叉点.
主要方法:
- 现有文献的叙述性审查.
- 对ICI-IA和RA进行比较分析.
- 综合关于免疫病原发生,临床特征和治疗策略的证据.
主要成果:
- ICI-IA和RA共享诸如多关节炎和侧关节炎等特征,但ICI-IA通常是血清阴性,并且发生在ICI启动后.
- 存在明显的免疫病理特征,包括ICI-IA中CD8+T细胞占主导地位.
- 慢性ICI-IA可以与更好的瘤结果相关,早期的风湿病转诊可以改善管理.
结论:
- 了解ICI-IA与RA之间的差异对于准确的诊断和个性化治疗至关重要.
- 治疗策略必须平衡关节炎控制与维持抗瘤免疫力.
- 葡萄皮质皮质激素和cDMARDs是第一线; 生物药物是为耐火病例保留的,考虑到癌症进展风险.
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