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Ghosh N, Jivanelli B, Couette N, Singh N, Kostine M, Simon Meara A, Liew DFL. The Need for Classification Criteria of Immune Checkpoint Inhibitor-induced inflammatory Arthritis: A Scoping Review. Rheum Dis Clin North Am 2024; 50:325-335. [PMID: 38670730 DOI: 10.1016/j.rdc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Immune checkpoint inhibitor-induced inflammatory arthritis (ICI-IA) is an immune-related adverse event that can occur as a result of receiving ICIs for cancer treatment. Thus far, ICI-IA has been described variably in the literature, in part due to varying presentations that evolve over time, as well as a lack of standardized definitions and classification. This scoping review aggregates various descriptions of ICI-IA, highlighting the most prominent attributes of ICI-IA from categories such as symptoms, signs, imaging, and laboratory findings as well as discussing potential mimic conditions.
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Affiliation(s)
- Nilasha Ghosh
- Department of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Bridget Jivanelli
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Nina Couette
- Department of Rheumatology, Rheumatology Care Center, Genesis Healthcare System, 2525 Maple Avenue, Zanesville, OH 43701, USA
| | - Namrata Singh
- Division of Rheumatology, Department of Medicine, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Marie Kostine
- Department of Rheumatology, Bordeaux University Hospital, 311 Président Wilson Boulevard, Bordeaux 33200, France
| | - Alexa Simon Meara
- Division of Oncology, Department of Medicine, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA
| | - David F L Liew
- Department of Rheumatology, Austin Health; Department of Clinical Pharmacology and Therapeutics, Austin Health; Department of Medicine, University of Melbourne, Level 1, North Wing, 300 Waterdale Road, PO Box 5444, Heidelberg West, Victoria 3081, Australia
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Ghosh N, Couette N, van Binsbergen WH, Weinmann SC, Jivanelli B, Shea B, Bass AR, Benesova K, Bingham CO, Calabrese C, Cappelli LC, Chan KK, Choy E, Daoussis D, Goodman S, Hudson M, Jamal S, Leipe J, Lopez-Olivo MA, Suarez-Almazor M, van der Laken CJ, Meara AS, Liew D, Kostine M. Identification of outcome domains in immune checkpoint inhibitor-induced inflammatory arthritis and polymyalgia rheumatica: A scoping review by the OMERACT irAE working group. Semin Arthritis Rheum 2023; 58:152110. [PMID: 36372016 PMCID: PMC10026626 DOI: 10.1016/j.semarthrit.2022.152110] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/22/2022] [Accepted: 08/05/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICI), increasingly used cancer therapeutics, can cause off-target inflammatory effects called immune-related adverse events (irAEs), including ICI-induced inflammatory arthritis (ICI-induced IA) and polymyalgia rheumatica (ICI-induced PMR). There are no validated classification criteria or outcome measures for these conditions, and adaptation of treatment recommendations from corresponding rheumatic diseases may not be appropriate. We summarized clinical descriptors of ICI-induced IA and ICI-induced PMR and aggregated domains used for these conditions in order to inform the development of a core set of outcome domains. METHODS As the initial step of the core domain set generation process, we systemically searched Medline (Pubmed), EMBASE, Cochrane, and CINHL through March 2021 to identify all studies that provide both clinical descriptions and domains relevant to ICI-induced IA and ICI-induced PMR. Domains were mapped to core areas, such as pathophysiological manifestations, life impact, resource use, and longevity/survival, as suggested by the OMERACT 2.1 Filter. RESULTS We identified 69 publications, over a third of which utilized non-specific diagnoses of "arthritis," "arthralgia," and/or "PMR". Other publications provided the number, the distribution and/or names of specific joints affected, while others labeled the irAE as the corresponding rheumatic disease, such as rheumatoid arthritis or spondyloarthritis. Most distinct domains mapped to the pathophysiology/manifestations core area (24 domains), such as signs/symptoms (13 domains), labs (6 domains), and imaging (5 domains), with harm domains of adverse effects from irAE treatment and fear of irAE treatment decreasing ICI efficacy. Forty-three publications also referenced irAE treatment and 35 subsequent response, as well as 32 tumor response. CONCLUSION There is considerable heterogeneity in the domains used to clinically characterize ICI-induced IA and ICI-induced PMR. There were several domains mapped to the pathophysiologic manifestations core area, although several publications highlighted domains evenly distributed among the other core areas of life impact, longevity/survival and resource use.
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Affiliation(s)
- Nilasha Ghosh
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery/Weill Cornell Medical College, 535 E 70th St, New York, NY, USA.
| | - Nina Couette
- Department of Internal Medicine. Division of Rheumatology & Immunology, The Ohio State University, Columbus, OH, USA
| | - Wouter H van Binsbergen
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology & Clinical Immunology, Amsterdam University Medical Center location DBL Amsterdam, the Netherlands
| | - Sophia C Weinmann
- Department of Rheumatology & Immunology, Duke University, Durham, NC, USA
| | - Bridget Jivanelli
- Hospital for Special Surgery, Kim Barrett Memorial Library, HSS Education Institute, New York, NY, USA
| | - Beverley Shea
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Anne R Bass
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery/Weill Cornell Medical College, 535 E 70th St, New York, NY, USA
| | - Karolina Benesova
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Clifton O Bingham
- Division of Rheumatology, Johns Hopkins University, Baltimore MD, USA
| | - Cassandra Calabrese
- Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Laura C Cappelli
- Division of Rheumatology, Johns Hopkins University, Baltimore MD, USA
| | - Karmela Kim Chan
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery/Weill Cornell Medical College, 535 E 70th St, New York, NY, USA
| | - Ernest Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Dimitrios Daoussis
- Department of Rheumatology, University of Patras Medical School, Patras University Hospital, Patras, Greece
| | - Susan Goodman
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery/Weill Cornell Medical College, 535 E 70th St, New York, NY, USA
| | - Marie Hudson
- Jewish General Hospital, Lady Davis Institute for medical research and McGill University, Montreal, Quebec, Canada
| | - Shahin Jamal
- Vancouver Coastal Health, University of British Columbia, Vancouver, BC, Canada
| | - Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Germany
| | | | - Maria Suarez-Almazor
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Conny J van der Laken
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology & Clinical Immunology, Amsterdam University Medical Center location DBL Amsterdam, the Netherlands
| | - Alexa Simon Meara
- Department of Internal Medicine. Division of Rheumatology & Immunology, The Ohio State University, Columbus, OH, USA
| | - David Liew
- Department of Rheumatology, Austin Health, Department of Clinical Pharmacology and Therapeutics, Austin Health, Australia, Department of Medicine, University of Melbourne, Parkville VIC, Australia
| | - Marie Kostine
- Bordeaux University Hospital, Department of Rheumatology, France
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Couette N, Jarjour W, Brammer JE, Simon Meara A. Pathogenesis and Treatment of T-Large Granular Lymphocytic Leukemia (T-LGLL) in the Setting of Rheumatic Disease. Front Oncol 2022; 12:854499. [PMID: 35747794 PMCID: PMC9209697 DOI: 10.3389/fonc.2022.854499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
A complex relationship exists between rheumatic diseases and cancer. This delicate balance between chronic inflammation and malignant cell transformation in hematologic neoplasms has been observed, but is not well defined. Large Granular Lymphocyte (LGL) leukemia is at the intersection of a clonal lymphoproliferative disease, chronic inflammation, and autoimmunity. The association between rheumatoid arthritis (RA) and the spectrum of Felty’s Syndrome is well-known. Other rheumatic disorders have been reported including systemic lupus erythematosus (SLE), Sjogren’s Syndrome (SS), vasculitis, Behcet’s Disease (BD) and systemic sclerosis. The association between T-LGLL and rheumatic disease pathogenesis has been hypothesized, but has not yet been fully understood. Components of a shared pathogenesis includes chronic antigen stimulation, JAK-STAT pathway activation and overlap of various cytokines. We will summarize current knowledge on the molecular understanding between T-LGLL and rheumatic disease. There are many potential areas of research to help meet this need and lead to development of targeted therapeutic options.
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Braunstein Z, McLaughlin E, Ruiz M, Wei L, Bumma N, Benson D, Devarakonda S, Chaudhry M, Khan A, Cottini F, Hanel W, Baiocchi R, Chung C, Addison D, Couette N, Meara A, Jarjour W, Porcu P, Mishra A, Reneau JC, Rosko AE, Brammer JE. Incidence, Treatment, and Survival of Patients With T-Cell Lymphoma, T-Cell Large Granular Leukemia, and Concomitant Plasma Cell Dyscrasias. Front Oncol 2022; 12:858426. [PMID: 35574379 PMCID: PMC9106372 DOI: 10.3389/fonc.2022.858426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
T-Cell malignancies are a group of heterogeneous disorders composed of primary cutaneous T-cell lymphomas (CTCLs), peripheral T-cell lymphomas (PTCLs), and T-cell leukemias, including T-cell large granular lymphocytic leukemia (T-LGLL). Cases of patients with combined T-cell malignancies and plasma cell dyscrasias (PCD) are reported in the literature, but these are mostly limited to case reports or small case series with <10 patients. Here, we described the clinical course of 26 patients and report baseline characteristics and clinical outcomes including overall survival (OS), progression-free survival (PFS), and objective response rates (ORRs) in this unique population. There was no survival difference in patients with CTCL or T-LGLL and concomitant PCD when treated with standard therapy directed at the T-cell malignancy when compared to historical controls. However, patients with PTCL and concomitant PCD had significantly inferior outcomes with rapid progression and worse OS and PFS at 1.7 years (p=0.006) and 4.8 months (p=0.08), respectively, when compared to historical controls for patients with PTCL, although the limited number of patients included in this analysis precludes drawing definitive conclusions. Treatment directed at the T-cell malignancy resulted in the eradication of the PCD clone in multiple patients (15.4%) including one with multiple myeloma (MM) who experienced a complete response after starting therapy directed at the T-cell malignancy. For patients with T-cell malignancies and concomitant PCD, treatment with standard T-cell-directed therapies is recommended based on this analysis with continued follow-up and monitoring of the concomitant PCD. Further studies are needed to definitively elucidate the increased risk of relapse in patients with PTCL and concomitant PCD, and larger, multi-center cohorts are needed to validate these findings across T-cell malignancies and PCDs.
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Affiliation(s)
- Zachary Braunstein
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Eric McLaughlin
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Miguel Ruiz
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Naresh Bumma
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Don Benson
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Srinivas Devarakonda
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Maria Chaudhry
- Division of Hematology, George Washington Cancer Center, George Washington University, Washington, DC, United States
| | - Abdullah Khan
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Francesca Cottini
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Walter Hanel
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Robert Baiocchi
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Catherine Chung
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Nina Couette
- Division of Rheumatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Alexa Meara
- Division of Rheumatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Wael Jarjour
- Division of Rheumatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Pierluigi Porcu
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology and Department of Cancer Biology, Sydney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Anjali Mishra
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sydney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - John C. Reneau
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Ashley E. Rosko
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Jonathan E. Brammer
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
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Abstract
A 50-year-old woman was referred to rheumatology for new onset polyarthralgia and headache. She had a history of metastatic lung adenocarcinoma and was started on treatment with the programmed death 1 receptor (PD-1) antagonist pembrolizumab 2 months prior. Examination revealed left temporal artery tenderness and hand synovitis. Investigations revealed enlarged temporal artery on ultrasound imaging. On steroid treatment, she had resolution of symptoms, but due to significant steroid side effects required methotrexate and her PD-1 antagonist therapy was continued in consultation with her oncologist. Her malignant disease has remained stable, and she has improved functional status.
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Affiliation(s)
- Nina Couette
- Rheumatology & Immunology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jisna Paul
- Rheumatology & Immunology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Mascarenhas S, Couette N. A Systematic Review of the Inclusion of Non-Inflammatory Ultrasonographic Enthesopathy Findings in Enthesitis Scoring Indices. Diagnostics (Basel) 2021; 11:diagnostics11040669. [PMID: 33917826 PMCID: PMC8068272 DOI: 10.3390/diagnostics11040669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Ultrasound has advanced the diagnosis and management of patients with inflammatory rheumatic conditions. It can be used to identify and monitor enthesitis, a cardinal feature of spondyloarthropthies. Several enthesitis scoring systems utilizing ultrasound to determine entheseal involvement have been developed. These scoring systems generally rely on determining the presence or absence of erosions, tendon enlargement, power Doppler signal, or enthesophytes. This systematic review identified ultrasound scoring systems that have been utilized for evaluating enthesitis and what key components derive the score. Review of these scoring systems, however, demonstrated confounding as some of the score components including enthesophytes may be seen in non-inflammatory conditions and some components including erosions can be seen from chronic damage, but not necessarily indicate active inflammatory disease. What is furthermore limiting is that currently there is not an agreed upon term to describe non-inflammatory enthesopathies, further complicating these scoring systems. This review highlights the need for a more comprehensive ultrasound enthesopathy scoring index.
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