Kobak Senol
Istinye University Faculty of Medicine, LIV Hospital, Department of Rheumatology, Istanbul, Turkey.
Curr Drug Saf. 2019;14(3):225-229. doi: 10.2174/1574886314666190528121039.
Immune checkpoint inhibitors (CPIs) are new promising anti-cancer drugs that block negative costimulation of T-cells leading to an enhanced anti-tumor immune response. Pembrolizumab, an a monoclonal antibody, targeting the programmed cell death protein 1 (PD-1) pathway. CPIs have been associated with a number of immune-related adverse events (AEs), including musculoskeletal and rheumatic disease.
To present a case with lung adenocarcinoma treated with pembrolizumab, which developed inflammatory arthritis and fasciitis.
A 73-year-old male patient was referred to the rheumatology outpatient clinic with complaints of pain in the pretibial area, pain and swelling in both ankles joints and the right fırst metacarpophalangeal (MCP) joint. Three months ago he had diagnosed with lung adenocarcinoma and pembrolizumab was started. Locomotor system complaints were started after receiving two infusions of pembrolizumab. Physical examination revealed both ankle arthritis, mild edema in the pretibial region, tenderness in the muscles and arthritis in the right fırst MCP joint. Laboratory examinations showed mild acute phase reactants elevation. Lower extremity MRI showed diffuse edema in both gastrocnemius muscle and fascia, compatible with fasciitis. Pembrolizumab-related fasciitis and seronegative arthritis were diagnosed. Low dose corticosteroid was started and a significant regression was observed in the patient's complaints.
Inflammatory myositis with fasciitis and inflammatory arthritis in lower extremities appears to be a new adverse effect of pembrolizumab therapy.
免疫检查点抑制剂（CPIs）是一类有前景的新型抗癌药物，可阻断T细胞的负性共刺激，从而增强抗肿瘤免疫反应。派姆单抗是一种靶向程序性细胞死亡蛋白1（PD-1）通路的单克隆抗体。CPIs与多种免疫相关不良事件（AEs）有关，包括肌肉骨骼和风湿性疾病。
报告1例接受派姆单抗治疗的肺腺癌患者发生炎性关节炎和筋膜炎的病例。
一名73岁男性患者因胫骨前区疼痛、双踝关节及右手第一掌指关节疼痛肿胀就诊于风湿病门诊。3个月前，他被诊断为肺腺癌并开始使用派姆单抗治疗。在接受两次派姆单抗输注后开始出现运动系统症状。体格检查发现双踝关节关节炎、胫骨前区轻度水肿、肌肉压痛及右手第一掌指关节关节炎。实验室检查显示急性期反应物轻度升高。下肢MRI显示双侧腓肠肌和筋膜弥漫性水肿，符合筋膜炎表现。诊断为派姆单抗相关的筋膜炎和血清阴性关节炎。开始使用低剂量皮质类固醇治疗，患者症状明显缓解。
伴有筋膜炎的炎性肌炎和下肢炎性关节炎似乎是派姆单抗治疗的一种新的不良反应。
