A collaborative effort between Rheumatology and Oncology offers guidance to doctors treating patients for inflammatory arthritis caused by treatment with “immune checkpoint inhibitors”, a type of cancer therapy.
Why was this study done?
New cancer therapies called immune checkpoint inhibitors work by increasing the body’s own immune response to fight cancer. They have been effective in treating advanced cancer, but can also cause severe side effects in some people, including inflammation in the joints (arthritis). This article offered preliminary recommendations for how doctors can evaluate and treat patients with inflammatory arthritis caused by treatment with immune checkpoint inhibitors. Currently no other recommendations exist to help clinicians diagnose and treat affected patients. Dr. Laura Cappelli, M.D., M.P.H, and co-authors, wanted to advance the field by offering suggestions based on their clinical experiences.
How was this study done?
The study built off past work by Johns Hopkins Rheumatology and Oncology that described a group of patients who developed inflammatory arthritis as a consequence of receiving immune checkpoint inhibitors for the treatment of cancer (“New cancer therapies linked to inflammatory arthritis and sicca syndrome”). The observations in that study were used to develop suggestions for how doctors should evaluate and manage patients with these side effects. These guidelines for management and evaluation will be refined as more is understood about this new rheumatic disease.
What were the major findings?
The study encouraged primary care doctors and oncologists to refer their patients to a rheumatologist quickly, if patients develop persistent swelling, pain or stiffness in their joints after immune checkpoint inhibition. Specific laboratory and imaging tests including X-rays were suggested, as helpful tools to determine if a patient has inflammatory arthritis. Treatment options were also suggested, including steroids and other medications that are commonly used by rheumatologists to treat patients with other types of arthritis.
What is the impact of this work?
This work will help oncology and rheumatology physicians improve the care for patients with inflammatory arthritis due to treatment with immune checkpoint inhibitors.
This research was supported by:
The Johns Hopkins Rheumatic Disease Research Core Center (RDRCC, P30-AR053503) and the Jerome L. Greene Foundation.
Link to original research article:
Inflammatory Arthritis: A Newly Recognized Adverse Event of Immune Checkpoint Blockade. Naidoo J, Cappelli LC, Forde PM, Marrone KA, Lipson EJ, Hammers HJ, Sharfman WH, Le DT, Baer AN, Shah AA, Albayda J, Manno RL, Haque U, Gutierrez AK, Bingham CO 3rd, Brahmer JR.
Oncologist. 2017 Jun 2. pii: theoncologist.2016-0390. doi: 10.1634/theoncologist.2016-0390. [Epub ahead of print] No abstract available.