Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Foundation, Cleveland, OH, USA.
Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Nat Rev Rheumatol. 2018 Oct;14(10):569-579. doi: 10.1038/s41584-018-0074-9.
Immunotherapy has revolutionized the treatment of cancer, but a rapid rise in the use of the family of therapeutic agents known as checkpoint inhibitors (CPIs) is associated with a new group of immune-related adverse events (irAEs) in almost any organ system. Among these irAEs, rheumatic complications are common and seem to have features that are distinct from irAEs in other organ systems, including a highly variable time of clinical onset and the capacity to persist, possibly indefinitely, even after cessation of CPI therapy. In this Review, mechanisms of action of CPIs and how they might cause rheumatic irAEs are described. Also covered are epidemiology and clinical descriptions of rheumatic irAEs, plus guiding principles for managing irAEs. Finally, we outline future directions that must be taken in response to a series of unanswered questions and unmet needs that now confront rheumatologists who are, or will be, engaged in this new area of rheumatology.
免疫疗法已经彻底改变了癌症的治疗方法，但一类被称为检查点抑制剂（CPIs）的治疗药物的使用迅速增加，这与几乎任何器官系统中出现的一组新的免疫相关不良事件（irAEs）有关。在这些 irAEs 中，风湿性并发症很常见，并且似乎具有与其他器官系统中的 irAEs 不同的特征，包括临床发病时间的高度可变性和持续存在的能力，即使在停止 CPI 治疗后也可能无限期地持续存在。在这篇综述中，描述了 CPIs 的作用机制以及它们如何引起风湿性 irAEs。还介绍了风湿性 irAEs 的流行病学和临床描述，以及 irAEs 管理的指导原则。最后，我们概述了必须针对一系列尚未解决的问题和未满足的需求采取的未来方向，这些问题和需求现在正摆在或即将摆在参与这一新领域的风湿病学家面前。
