Background:
Rheumatic immune related adverse events are increasingly recognised and amongst patients receiving immune checkpoint inhibitors for metastatic cancer. The aim of the study is to describe the manifestations, natural history, and outcome of rheumatic irAEs in these patients to improve ourunderstanding of these syndromes.
Methods:
We performed a retrospective review of patients referred to our rheumatology practice for the management of rheumatic syndromes that had developed during ICI therapies for metastatic melanoma from Jan 2015 to Dec 2018. Patients’ demographics, rheumatic manifestations, baseline inflammatory markers, autoimmune serology and treatment were reviewed.
Results:
From January 2015 to December 2018, there were nineteen patients referred to our rheumatology practice while receiving ICI therapy for metastatic melanoma. Table one lists the characteristics of these patients with their rheumatic manifestations, treatment, and outcomes. There was equal sex preponderance (nine males and 10 females). Inflammatory arthritis was the most common rheumatic irAE (10 peripheral and 4 axial). PMR-like syndromes were common and responsive to corticosteroids. One developed Sjögren-like syndrome with sicca symptoms and parotid gland swelling. One developed a dermatomyositis-like syndrome with pre-dominantly skin involvement. One had a flare of gout. Traditional serological markers were usually negative. Treatment included corticosteroids, csDMARDsand bDMARDs such as anti-TNF. In a number of patients ICI were stopped.
Conclusions:
ICI therapy causes a wide variety of rheumatic irAEs which may complicate the course of treatment of metastatic melanoma. Referral has often been due to raised ESR and CRP in association with symptoms. The immunotherapy can usually be continued on mediation.