De Camps Martinez Elmer R, Gonzalez Camila, Hassan Hamzah, Hassan Hafsa, Hassan Farooq
Internal Medicine, Northeast Ohio Medical University, Rootstown, USA.
Genomic Medicine Institute, Cleveland Clinic, Cleveland, USA.
Cureus. 2023 Jul 5;15(7):e41394. doi: 10.7759/cureus.41394. eCollection 2023 Jul.
Immune checkpoint inhibitors (ICIs) are a widely used class of cancer immunotherapy. Those drugs have improved the treatment of cancer since its introduction in the 2000s. Nivolumab is an ICI that can be used for previously untreated renal cell carcinoma. Immune-related adverse events (irAEs) are a type of adverse event of immunotherapy that is associated with an overreactive immune system. We report a case of a 69-year-old Caucasian man with stage IV renal cell carcinoma who presented to a rural community-based rheumatology clinic referred by his oncologist, after starting to develop morning stiffness for at least three hours, joint swelling, warmth, and erythema five months after starting immunotherapy with nivolumab. The patient was diagnosed with seronegative rheumatoid arthritis secondary to ICIs and required a higher dose of prednisone (up to 40 mg per day) with methotrexate to achieve remission. With the widespread availability of ICIs, rheumatologic irAEs can be encountered in a rural community-based practice. Practicing physicians taking care of cancer patients need to be aware of the adverse effect of ICIs.
免疫检查点抑制剂（ICIs）是一类广泛应用的癌症免疫疗法药物。自21世纪初引入以来，这些药物改善了癌症的治疗效果。纳武单抗是一种可用于既往未治疗的肾细胞癌的ICIs。免疫相关不良事件（irAEs）是免疫疗法的一种不良事件，与免疫系统过度反应有关。我们报告一例69岁的白种男性IV期肾细胞癌患者，在开始使用纳武单抗免疫治疗五个月后，出现至少三小时的晨僵、关节肿胀、发热和红斑，由肿瘤学家转诊至一家农村社区风湿病诊所。该患者被诊断为继发于ICIs的血清阴性类风湿关节炎，需要更高剂量的泼尼松（每日高达40毫克）联合甲氨蝶呤来实现缓解。随着ICIs的广泛应用，在农村社区医疗实践中可能会遇到风湿性irAEs。治疗癌症患者的执业医师需要了解ICIs的不良反应。
