Bernabela Luigino, Bermas Bonnie
Division of Rheumatic Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Curr Rheumatol Rep. 2024 Nov 26;27(1):3. doi: 10.1007/s11926-024-01173-6.
Immune checkpoint inhibitors (ICI) have revolutionized cancer therapy over the past decade. Unfortunately, immune related adverse events (irAEs) are common, including rheumatologic adverse events. These rheumatologic irAEs include de novo rheumatoid arthritis-like presentations or flares of pre-existing rheumatoid arthritis, collectively called ICI-associated rheumatoid arthritis. In this article we review the different mechanisms of disease activity and management approaches including use of conventional (cs) DMARDs and biologic (b) DMARDs in this patient population. Other forms of ICI-induced inflammatory arthritis e.g., PMR-like or Spondylarthritis-type IA, are beyond the scope of this review.
The heterogeneous presentations of inflammatory arthritis in patients receiving immune checkpoint inhibitors has made this a challenging area to study. Nonetheless, recent studies are providing better understanding on the mechanisms of de novo disease and flares in patients with rheumatoid arthritis. About half of patients with pre-existing rheumatoid arthritis flare after receiving checkpoint inhibitors. Persistent arthritis is often encountered in patients receiving combination immune checkpoint inhibitors. Outcomes on overall survival do not differ in rheumatoid arthritis patients receiving checkpoint inhibitors compared to their non-arthritis counterparts. Rheumatologist play a critical role in the management of active rheumatoid arthritis induced by checkpoint inhibitors. Collaboration with oncology colleagues will continue to be a crucial component in providing quality care to these patients. While the use of glucocorticoids is often the first line therapy for active inflammatory arthritic disease, we recommend earlier consideration of DMARDs just as we inverted the treatment pyramid several decades ago, for rheumatoid arthritis.
在过去十年中，免疫检查点抑制剂（ICI）彻底改变了癌症治疗方式。不幸的是，免疫相关不良事件（irAE）很常见，包括风湿性不良事件。这些风湿性irAE包括新发类风湿关节炎样表现或既往类风湿关节炎的发作，统称为ICI相关类风湿关节炎。在本文中，我们回顾了疾病活动的不同机制以及管理方法，包括在该患者群体中使用传统（cs）改善病情抗风湿药（DMARD）和生物（b）DMARD。其他形式的ICI诱导的炎性关节炎，例如，巨细胞动脉炎样或脊柱关节炎型炎性关节炎，不在本综述范围内。
接受免疫检查点抑制剂的患者中炎性关节炎的异质性表现使其成为一个具有挑战性的研究领域。尽管如此，最近的研究对类风湿关节炎患者新发疾病和发作的机制有了更好的理解。大约一半的既往类风湿关节炎患者在接受检查点抑制剂后病情发作。接受联合免疫检查点抑制剂的患者经常会出现持续性关节炎。与未患关节炎的患者相比，接受检查点抑制剂的类风湿关节炎患者的总生存结果并无差异。风湿病学家在管理由检查点抑制剂引起的活动性类风湿关节炎中起着关键作用。与肿瘤学同事的合作仍将是为这些患者提供优质护理的关键组成部分。虽然糖皮质激素的使用通常是活动性炎性关节炎疾病的一线治疗方法，但我们建议像几十年前治疗类风湿关节炎那样，更早地考虑使用DMARD。
