Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Curr Opin Rheumatol. 2020 May;32(3):315-320. doi: 10.1097/BOR.0000000000000701.
This review summarizes the current evidence on treatment strategies for inflammatory arthritis because of cancer treatment with immune checkpoint inhibitors (ICI), prognosis of ICI-induced arthritis, and management of patients with preexisting inflammatory arthritis receiving ICI therapy.
Inflammatory arthritis is the most common rheumatic immune-related adverse event observed in patients receiving ICI therapy. Most patients can successfully be treated with low doses of corticosteroids or conventional synthetic disease modifying anti-rheumatic drugs (DMARDs). A small minority will develop severe symptoms requiring biologic therapy including TNF inhibitors and IL-6 receptor inhibitors. Many cases of inflammatory arthritis will resolve with cessation of ICI therapy. Some patients will develop persistent arthritis despite discontinuation. Patients with preexisting inflammatory arthritis (e.g. rheumatoid arthritis) commonly flare on ICI therapy, but can usually be managed with corticosteroids.
Inflammatory arthritis following ICI therapy for cancer is relatively common and the practicing rheumatologist should be able to recognize and manage it in conjunction with Oncology. The majority of patients respond to corticosteroids, but some will need treatment with conventional synthetic or biologic DMARDs. Additional studies should investigate the effects of immunosuppression on tumor response and the use of ICI therapy in patients with preexisting autoimmune disease.
本文总结了癌症免疫检查点抑制剂（ICI）治疗相关炎性关节炎的治疗策略、ICI 诱导性关节炎的预后，以及合并预先存在炎性关节炎患者接受 ICI 治疗的管理等方面的最新进展。
ICI 治疗相关最常见的风湿免疫相关不良反应是炎性关节炎。大多数患者经低剂量皮质类固醇或传统合成的改善病情抗风湿药物（csDMARDs）治疗即可有效缓解。极少数患者会出现严重症状，需要使用生物制剂（如 TNF 抑制剂和 IL-6 受体抑制剂）治疗。停止 ICI 治疗后，多数炎性关节炎患者的症状可缓解。部分患者即便停药后仍存在持续性关节炎。合并预先存在炎性关节炎（如类风湿关节炎）的患者在接受 ICI 治疗后常会出现疾病活动，此时通常可通过皮质类固醇治疗进行管理。
ICI 治疗癌症后出现炎性关节炎较为常见，风湿科医生应与肿瘤医生共同识别和管理此类疾病。大多数患者对皮质类固醇治疗有反应，但部分患者可能需要使用 csDMARDs 或生物制剂进行治疗。还需进一步研究免疫抑制对肿瘤应答的影响，以及 ICI 治疗在合并预先存在自身免疫性疾病患者中的应用。
