Institute of Immunology and Immunotherapy, Birmingham, UK.
Cancer Centre, University Hospital Birmingham, Birmingham, UK.
Rheumatology (Oxford). 2019 Dec 1;58(Suppl 7):vii29-vii39. doi: 10.1093/rheumatology/kez536.
Immune checkpoint inhibitors (CPIs) are an effective treatment for many cancers but cause diverse immune-related adverse events (IrAEs). Rheumatological IrAEs include arthralgia, arthritis, tenosynovitis, myositis, polymyalgia rheumatica and sicca syndrome. CPI use can unmask RA as well as causing flares of prior autoimmune or connective tissue disease. Oncologists categorize and grade IrAEs using the Common Terminology Criteria for Adverse Events and manage them according to international guidelines. However, rheumatological events are unfamiliar territory: oncologists need to work with rheumatologists to elicit and assess symptoms, signs, results of imaging and autoantibody testing and to determine the use of steroids and DMARDs. Myositis may overlap with myasthenic crisis and myocarditis and can be life-threatening. Treatment should be offered on balance of risk and benefit, including whether to continue CPI treatment and recognizing the uncertainty over whether glucocorticoids and DMARDs might compromise cancer control.
免疫检查点抑制剂 (CPIs) 是许多癌症的有效治疗方法，但会引起多种免疫相关不良事件 (IrAEs)。风湿免疫相关不良事件包括关节痛、关节炎、腱鞘炎、肌炎、巨细胞动脉炎和干燥综合征。CPIs 的使用不仅可引发 RA，还可导致先前自身免疫或结缔组织疾病的发作。肿瘤学家使用不良事件通用术语标准对 IrAEs 进行分类和分级，并根据国际指南进行管理。然而，风湿性疾病是肿瘤学家不熟悉的领域：他们需要与风湿病学家合作，以引出并评估症状、体征、影像学和自身抗体检测结果，并确定是否使用类固醇和 DMARDs。肌炎可能与肌无力危象和心肌炎重叠，可能危及生命。应根据风险和获益平衡来提供治疗，包括是否继续 CPI 治疗，以及是否认识到糖皮质激素和 DMARDs 是否可能影响癌症控制存在不确定性。
