EULAR Centre for Arthritis and Rheumatic Disease, St. Vincent's University Hospital, Dublin, Ireland.
Molecular Rheumatology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.
BMJ Case Rep. 2021 Feb 4;14(2):e238851. doi: 10.1136/bcr-2020-238851.
Immune checkpoint inhibitors have revolutionised cancer treatment; however, immune-related adverse events do occur, with up to 7% developing inflammatory arthritis. Common rheumatoid arthritis therapies such as methotrexate, prednisolone and biologics have been used to treat this arthritis in small, uncontrolled case series with varying success. In this case of personalised medicine, we report the first use of tofacitinib, a small molecular inhibitor of the Janus kinase-signal transducer and activator of transcription pathway, to treat checkpoint inhibitor-related inflammatory arthritis. This resulted in a rapid clinical response and complete, sustained remission of the arthritis with associated marked reduction in synovial molecular and cellular immune response.
免疫检查点抑制剂彻底改变了癌症治疗；然而，免疫相关不良反应确实会发生，多达 7%的患者会发生炎症性关节炎。在一些小型、非对照的病例系列研究中，曾使用甲氨蝶呤、泼尼松龙和生物制剂等常见的类风湿关节炎治疗药物来治疗此类关节炎，但疗效不一。在这种个体化医学的情况下，我们报告了使用托法替布（一种 Janus 激酶信号转导和转录激活因子通路的小分子抑制剂）治疗检查点抑制剂相关炎症性关节炎的首例病例。这导致了快速的临床反应和关节炎的完全、持续缓解，同时也显著降低了滑膜分子和细胞免疫反应。
