1
|
Rouhi A, Jamal S, Arreola LG, Moon D, Hudson M, Roberts J, Ladouceur A, Ye C. Immune Checkpoint Inhibitor-Associated Remitting Seronegative Symmetrical Synovitis With Pitting Edema: Description of a New Entity by CanRIO. J Rheumatol 2024; 51:523-528. [PMID: 38428960 DOI: 10.3899/jrheum.2023-0969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is characterized by symmetrical synovitis with pitting edema and negative rheumatoid factor (RF). It has been described in a setting of malignancy, suggesting a paraneoplastic association. With the increasing use of immune checkpoint inhibitors (ICIs) for the treatment of cancers and emergence of immune-related adverse events (irAEs), our objective was to identify and describe cases of ICI-associated RS3PE (ICI-RS3PE) and compare them to non-ICI-RS3PE. METHODS The Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO) network is a collaboration of Canadian rheumatologists with experience in the management of patients with rheumatic irAEs (Rh-irAEs). Standardized data on adult patients with Rh-irAE have been collected as part of retrospective and prospective cohorts. In this study, detailed information on all cases of ICI-RS3PE from both cohorts were extracted and analyzed. RESULTS We identified 11 cases of ICI-RS3PE. The most frequently observed malignancy was nonsmall cell lung cancer (4 of 11), followed by malignant melanoma (2 of 11) and cutaneous squamous cell carcinoma (2 of 11). The median time to onset of ICI-RS3PE was 26 weeks from ICI start and 52 weeks from diagnosis of malignancy. Seven patients had stable cancer prior to onset of ICI-RS3PE, 3 had partial response, and 1 had complete response. All patients received glucocorticoids. Conventional synthetic disease-modifying antirheumatic drugs (csDMARD) were needed in 10 patients. CONCLUSION ICI-RS3PE may be an independent Rh-irAE, separate from paraneoplastic RS3PE. The symptoms of ICI-RS3PE responded well to glucocorticoids, but concomitant treatment with csDMARDs may be necessary.
Collapse
Affiliation(s)
- Azin Rouhi
- A. Rouhi, MD, D. Moon, BSc, C. Ye, MD, University of Alberta, Edmonton, Alberta
| | - Shahin Jamal
- S. Jamal, MD, MSc, L.G. Arreola, MSc, University of British Columbia, Vancouver, British Columbia
| | - Lourdes Gonzales Arreola
- S. Jamal, MD, MSc, L.G. Arreola, MSc, University of British Columbia, Vancouver, British Columbia
| | - David Moon
- A. Rouhi, MD, D. Moon, BSc, C. Ye, MD, University of Alberta, Edmonton, Alberta
| | - Marie Hudson
- M. Hudson, MD, MPH, A. Ladouceur, MD, PhD, McGill University, Montreal, Quebec
| | - Janet Roberts
- J. Roberts, MD, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexandra Ladouceur
- M. Hudson, MD, MPH, A. Ladouceur, MD, PhD, McGill University, Montreal, Quebec
| | - Carrie Ye
- A. Rouhi, MD, D. Moon, BSc, C. Ye, MD, University of Alberta, Edmonton, Alberta;
| |
Collapse
|
2
|
Abstract
PURPOSE OF REVIEW Immune check point inhibitors (ICIs) are a unique class of cancer treatments that harness the body's innate antitumor response. Although these medications have transformed oncology care, they also lead to generalized immune activation that can result in toxicities across a spectrum of organ systems called immune-related adverse events. This article reviews the most common rheumatologic immune-related adverse events and their management. RECENT FINDINGS Inflammatory arthritis, polymyalgia rheumatic, sicca symptoms, systemic sclerosis, myositis, and vasculitis have all been reported as ICI adverse events. Treatment includes nonsteroidal anti-inflammatory drugs, glucocorticoids, traditional DMARDs, and biologics. SUMMARY Rheumatologists have an important role in the management of patients with rheumatologic immune-related adverse events. Working with our oncology colleagues, we can help manage rheumatologic immune-related adverse events while optimally preserving ICI's antitumor effects.
Collapse
Affiliation(s)
- Melissa Defoe
- Division of Rheumatic Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | |
Collapse
|