Gediz Fusun, Kobak Senol
Department of Hematology, Transplantation Unit, Izmir Training and Research Hospital, Bone Marrow, Izmir, Turkey.
Department of Rheumatology, Istinye University Faculty of Medicine, Liv Hospital, Istanbul, Turkey.
Curr Rheumatol Rev. 2019;15(3):201-208. doi: 10.2174/1573397115666190119094736.
Immune checkpoint inhibitors are revolutionized drugs for cancer immunotherapy in the last years. The mechanism of action of CPIs including the limitation of the activation of Tcells, and thus enhancing the self-immune response against tumour cells. Checkpointinhibitors( CPIs) may dysregulate the immune system, resulting in some toxicities. These toxicities or side effects are called Immune-related Adverse Events (IRAEs) that can potentially affect any organ and tissue. Rheumatic diseases due to checkpoint inhibitors are also reported in the literature. The spectrum of rheumatic manifestations are quite wide; the most common are arthralgia/arthritis, myalgia/myositis, polimyalgia rheumatica, lupus, rheumatoid arthritis, Sjögren's syndrome. At the same time, these drugs can also cause an exacerbation of known rheumatologic disease. Treatment approaches for developing rheumatic findings due to checkpoint inhibitors should be multidisciplinary. There should be a close relationship between oncologists who follow-up these patients and rheumatologists. The rheumatic manifestations should be defined and treated early. In general, the musculoskeletal side effects are transient and may regress after stopping CPIs. The most commonly used medications are corticosteroids. Immunosuppressive drugs (HQ, MTX, anti-TNF-alpha, anti-IL-6) should be preferred when treatment is unresponsive or as steroid-sparing agents. The aim of this review was to evaluate the checkpoint inhibitors-related rheumatologic findings and therapeutic strategies in light of recent literature data.
免疫检查点抑制剂是近年来癌症免疫治疗的革命性药物。免疫检查点抑制剂（CPIs）的作用机制包括限制T细胞的激活，从而增强针对肿瘤细胞的自身免疫反应。检查点抑制剂可能会使免疫系统失调，导致一些毒性反应。这些毒性反应或副作用被称为免疫相关不良事件（IRAEs），可能会影响任何器官和组织。文献中也报道了由检查点抑制剂引起的风湿性疾病。风湿性表现的范围相当广泛；最常见的是关节痛/关节炎、肌痛/肌炎、风湿性多肌痛、狼疮、类风湿关节炎、干燥综合征。同时，这些药物也可能导致已知风湿性疾病的加重。针对检查点抑制剂引起的风湿性疾病的治疗方法应该是多学科的。随访这些患者的肿瘤学家和风湿病学家之间应该保持密切的关系。风湿性表现应该尽早明确并治疗。一般来说，肌肉骨骼副作用是短暂的，停用CPIs后可能会消退。最常用的药物是皮质类固醇。当治疗无效或作为类固醇节省剂时，应首选免疫抑制药物（羟基氯喹、甲氨蝶呤、抗TNF-α、抗IL-6）。这篇综述的目的是根据最近的文献数据评估与检查点抑制剂相关的风湿性疾病表现和治疗策略。
