Kawashiri Shin-Ya, Iwamoto Naoki, Ohba Kojiro, Kawakami Atsushi
Departments of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Case Rep Rheumatol. 2019 Jul 24;2019:7340692. doi: 10.1155/2019/7340692. eCollection 2019.
A 71-year-old Japanese woman was treated with programmed cell death protein-1 (PD-1) inhibitor, nivolumab, for renal cell carcinoma with lung metastasis. Although she had been treated with antirheumatic drugs from 40 to 60 years old by the diagnosis of seronegative inflammatory arthritis, treatment was discontinued based on her achievement of remission. She developed severe polyarthralgia after the administration of nivolumab. Severe synovitis with remarkable power Doppler signals was detected by ultrasound in multiple joints and tendons, and her serum levels of proinflammatory cytokine were remarkably elevated. Nevertheless, her arthritis disappeared after the discontinuation of nivolumab and treatment with a glucocorticoid without antirheumatic drugs. The use of PD-1 inhibitor may be restricted in patients predisposed to arthritis. Alternatively, a close monitoring of these patients by rheumatologists is necessary to identify predictable flares.
一名71岁的日本女性因肾细胞癌伴肺转移接受程序性细胞死亡蛋白1（PD-1）抑制剂纳武单抗治疗。尽管她在40至60岁时被诊断为血清阴性炎性关节炎并接受了抗风湿药物治疗，但基于病情缓解，治疗已停止。在使用纳武单抗后，她出现了严重的多关节痛。超声检查发现多个关节和肌腱有严重滑膜炎，且有明显的能量多普勒信号，她的促炎细胞因子血清水平显著升高。然而，在停用纳武单抗并使用糖皮质激素治疗（未使用抗风湿药物）后，她的关节炎消失了。对于易患关节炎的患者，PD-1抑制剂的使用可能会受到限制。或者，风湿病学家对这些患者进行密切监测以识别可预测的病情发作是必要的。
