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Autoimmunity
Clinical case
Characteristics and treatment of new-onset arthritis after checkpoint inhibitor therapy
  1. Jan Leipe1,
  2. Lisa A Christ1,
  3. Andreas P Arnoldi2,
  4. Erik Mille3,
  5. Frank Berger2,
  6. Markus Heppt4,
  7. Ilana Goldscheider4,
  8. Diego Kauffmann-Guerrero5,
  9. Rudolf M Huber5,
  10. Claudia Dechant1,
  11. Carola Berking4,
  12. Hendrik Schulze-Koops1 and
  13. Alla Skapenko1
  1. 1 Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians-University Munich, Munich, Germany
  2. 2 Department of Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
  3. 3 Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
  4. 4 Department of Dermatology and Allergology, Ludwig-Maximilians-University Munich, Munich, Germany
  5. 5 Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Munich, Germany
  1. Correspondence to Jan Leipe; jan.leipe{at}med.uni-muenchen.de

Abstract

Immune checkpoint inhibitors (ICIs) may cause immune-related adverse events (IRAEs). Characterisation and data on treatment of musculoskeletal IRAEs are scarce. In this cohort study, patients receiving ICI therapy who experienced arthralgia were evaluated for the presence of synovitis. Data on demographics, ICI regime, time of onset, imaging and response to therapy of synovitis were prospectively collected. Arthritis was demonstrated in 14 of 16 patients of whom 7 showed monarthritis, 5 had oligoarthritis and 2 had polyarthritis. Patients with ICI-induced arthritis were predominantly male (57%) and seronegative (69%). Regarding the detection of synovitis in staging imaging, moderate sensitivity for contrast-enhanced CT with PET-CT as reference was observed. Disease burden at baseline was high and was significantly reduced after anti-inflammatory treatment. Nine patients were treated with systemic and eight patients with intra-articular glucocorticoids. Six patients who flared on glucocorticoid treatment on tapering were given methotrexate resulting in long-term remission. Patients with synovitis were more likely to have good tumour response. Patients with ICI-induced arthritis were predominantly male and seronegative showing different patterns of arthritis with high disease burden. Good efficacy and safety was observed for methotrexate, particularly for ICI-induced polyarthritis.

  • checkpoint inhibitors
  • arthritis
  • polymyalgia rheumatica
  • nivolumab
  • pembrolizumab
  • ipilimumab
  • methotrexate

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2018-000714

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    Footnotes

    • JL and LAC contributed equally.

    • Contributors All authors contributed to data acquisition, analysis and manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Local ethics committee (LMU).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.