Checkpoint Inhibitor-Associated Arthritis: A Systematic Review of Case Reports and Case Series.
Checkpoint Inhibitor-Associated Arthritis: A Systematic Review of Case Reports and Case Series.
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DOI：
10.1097/rhu.0000000000001370
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发表时间：
2021-12-01
期刊：
影响因子：
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通讯作者：
Bass AR
中科院分区：
文献类型：
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作者：
Ghosh N;Tiongson MD;Stewart C;Chan KK;Jivanelli B;Cappelli L;Bass AR
我们进行了系统的文献综述，以确定免疫检查点相关炎性关节炎的所有报告，以描述其表型和血清学。检索PubMed、Embase和科克伦数据库中继发于ICI治疗的肌肉骨骼免疫相关不良事件报告。如果出版物提供了关于关节受累模式的个体患者水平数据，则将其纳入。使用描述性统计量总结结果。共筛选了4339篇文章，其中纳入67篇，包含372例患者。大多数患者患有转移性黑色素瘤（57%），并接受抗PD1或抗PDL 1治疗（78%）。至关节炎发作的中位时间为4个月（范围：1天至53个月）。49%的人患有多关节炎，17%的人患有少关节炎，3%的人患有单关节炎，10%的人患有关节痛，21%的人患有风湿性多肌痛。超过一半的患者被描述为具有“类风湿性关节炎样”表现。9%的人检测出类风湿因子或抗环瓜氨酸肽抗体阳性。74%的人需要皮质类固醇，45%的人需要额外的药物。63%的患者关节炎得到控制，32%的患者最终能够停止抗风湿治疗。49%的患者继续使用免疫检查点抑制剂，11%的患者暂时停用，13%的患者因肌肉骨骼免疫相关不良事件而永久停用。报告的免疫检查点相关关节炎病例中有一半存在多发性关节炎（通常是类RA），但只有9%是血清阳性。风湿性多肌痛也很常见。大多数患者对类固醇有反应，但大约一半需要额外的药物。需要进一步的研究来确定这些患者的长期肌肉骨骼结局，以及关节炎治疗对癌症生存率的影响。
We performed a systematic literature review to identify all reports of immune checkpoint inhibitor–associated inflammatory arthritis to describe it phenotypically and serologically. PubMed, Embase, and Cochrane databases were searched for reports of musculoskeletal immune-related adverse events secondary to ICI treatment. Publications were included if they provided individual patient level data regarding the pattern of joint involvement. Descriptive statistics were used to summarize results. A total of 4339 articles were screened, of which 67 were included, encompassing 372 patients. The majority of patients had metastatic melanoma (57%), and they were treated with anti-PD1 or anti-PDL1 therapy (78%). Median time to onset of arthritis was 4 months (range, 1 day to 53 months). Forty-nine percent had polyarthritis, 17% oligoarthritis, 3% monoarthritis, 10% arthralgia, and 21% polymyalgia rheumatica. More than half of patients were described as having a “rheumatoid arthritis– like” presentation. Nine percent tested positive for rheumatoid factor or anti–cyclic citrullinated peptide antibodies. Seventy-four percent required corticosteroids, and 45% required additional medications. Sixty-three percent achieved arthritis control, and 32% were ultimately able to discontinue antirheumatic treatments. Immune checkpoint inhibitors were continued in 49%, transiently withheld in 11%, and permanently discontinued due to musculoskeletal immune-related adverse events in 13%. Half of reported immune checkpoint inhibitor–associated arthritis cases present with polyarthritis (often RA-like), but only 9% are seropositive. Polymyalgia rheumatica is also common. Most patients respond to steroids alone, but about half require additional medications. Further studies are needed to determine long-term musculoskeletal outcomes in these patients, and the impact of arthritis treatment on cancer survival.