Chan Karmela K, Bass Anne R
Department of Medicine, Hospital for Special Surgery/Weill Cornell Medicine, New York, NY, USA.
J Inflamm Res. 2022 May 25;15:3105-3118. doi: 10.2147/JIR.S282600. eCollection 2022.
In this review, we draw from observational studies, treatment guidelines and our own clinical experience to describe approaches to monitoring and management of immune checkpoint inhibitor (ICI)-induced inflammatory arthritis, including polymyalgia rheumatica. This condition occurs in about 4% of ICI-treated cancer patients and can persist for a year or longer. Mild arthritis can generally be managed with non-steroidal anti-inflammatory drugs, intraarticular steroids injections and/or low dose corticosteroids. Higher grade arthritis should be brought under control with corticosteroids, but early introduction of a steroid-sparing agent is recommended to minimize steroid toxicity. In order to assess the effectiveness of any arthritis treatment, tender and swollen joint counts and patient reported measures of physical function, such as the health assessment questionnaire, should be obtained at each visit. Referral to a rheumatologist is recommended for patients with high grade arthritis to help guide the use of disease-modifying antirheumatic drugs.
在本综述中,我们借鉴观察性研究、治疗指南以及我们自己的临床经验,来描述监测和管理免疫检查点抑制剂(ICI)诱导的炎性关节炎(包括风湿性多肌痛)的方法。这种情况发生在约4%接受ICI治疗的癌症患者中,并且可能持续一年或更长时间。轻度关节炎通常可用非甾体抗炎药、关节内注射类固醇和/或低剂量皮质类固醇进行管理。更严重的关节炎应由皮质类固醇控制,但建议尽早引入类固醇节约剂以尽量减少类固醇毒性。为了评估任何关节炎治疗的效果,每次就诊时应获取压痛和肿胀关节计数以及患者报告的身体功能指标,如健康评估问卷。对于重度关节炎患者,建议转诊至风湿病专家处,以帮助指导使用改善病情抗风湿药。