Calabrese C, Kirchner E, Kontzias A, Velcheti V, Calabrese L H
Cleveland Clinic Foundation, Cleveland, Ohio, USA; Departmentof Rheumatology and Immunology, Cleveland Clinic, Cleveland, Ohio, USA.
Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio, USA.
RMD Open. 2017 Mar 20;3(1):e000412. doi: 10.1136/rmdopen-2016-000412. eCollection 2017.
Immunotherapy of cancer with checkpoint inhibitors has been associated with a spectrum of autoimmune and systemic inflammatory reactions known as immune-related adverse events (irAEs). Rheumatic irAEs are infrequently reported and extensively described. Here, we report our experience over an 18-month period with 15 patients evaluated in the rheumatology department for rheumatic irAEs. We identified 13 patients without pre-existing autoimmune disease (AID) who subsequently developed rheumatic irAEs, and two with established AID referred pre-emptively. irAEs encountered included: inflammatory arthritis, sicca syndrome, polymyalgia rheumatica-like symptoms and myositis. All cases required glucocorticoids, and three required a biological agent. Rheumatic irAEs led to temporary or permanent cessation of immunotherapy in all but five patients. One patient with pre-existing AID experienced a flare after starting immunotherapy. Our findings underscore that rheumatic irAEs are complex, at times require additional immunosuppressive therapy, and may influence ongoing immunotherapy regimens for the primary disease. Similar irAEs will be increasingly seen as checkpoint inhibitors adopted as standard of care in the community.
使用检查点抑制剂进行癌症免疫治疗与一系列自身免疫和全身炎症反应相关，这些反应被称为免疫相关不良事件（irAE）。风湿性irAE的报告较少且描述不充分。在此，我们报告了在18个月期间，15例因风湿性irAE在风湿科接受评估的患者的情况。我们确定了13例无既往自身免疫性疾病（AID）的患者，这些患者随后出现了风湿性irAE，以及2例已确诊AID并被提前转诊的患者。所遇到的irAE包括：炎性关节炎、干燥综合征、风湿性多肌痛样症状和肌炎。所有病例均需要使用糖皮质激素，3例需要使用生物制剂。除5例患者外，风湿性irAE导致所有患者暂时或永久停止免疫治疗。1例有既往AID的患者在开始免疫治疗后病情加重。我们的研究结果强调，风湿性irAE很复杂，有时需要额外的免疫抑制治疗，并且可能会影响原发性疾病正在进行的免疫治疗方案。随着检查点抑制剂在社区中成为标准治疗方法，类似的irAE将会越来越常见。
