Erosive Deforming Inflammatory Arthritis in a Patient With Cervical Adenocarcinoma

Abstract

A 58-year-old white woman with history of metastatic human papillomavirus-positive cervical adenocarcinoma presented with multiple joint deformities. Her initial symptoms started 1 month after the initiation of nivolumab, which was 1 year prior to the index visit. Treatment with nonsteroidal anti-inflammatory drugs failed, and the patient had a partial response to intra-articular steroids. She refused systemic therapies owing to concern about diminishing the effectiveness of nivolumab. Despite the joint symptoms, nivolumab treatment was continued for a year. Evaluation showed fixed swan neck deformities in multiple fingers (Figure , A). There was evidence of chronic synovial hypertrophy with no active synovitis on examination. The results of a comprehensive autoantibody blood panel, including antinuclear antibody, rheumatoid factor, and anti-citrullinated peptide antibody, were unremarkable. Plain radiographs of the hands demonstrated diffuse osteopenia, joint space narrowing, and multiple deformities. Magnetic resonance imaging of both hands revealed multifocal osseous erosions (Figure , B), synovitis, and tenosynovitis. DiagnosisC. Nivolumab-induced inflammatory arthritis 9. Schadendorf D, Wolchok JD, Hodi FS, et al. Efficacy and safety outcomes in patients with advanced melanoma who discontinued treatment with nivolumab and ipilimumab because of adverse events: a pooled analysis of randomized phase II and III trials.

Use of Magnetic Resonance Imaging to Identify Immune Checkpoint Inhibitor–Induced Inflammatory Arthritis

“…As reported previously, patient 4 developed arthritis 4 weeks after nivolumab initiation. Despite persistent IA, ICI was continued for 1 year owing to the patient’s apprehension of stopping ICI treatment or receiving systemic therapies for her symptoms, during which period she developed erosive disease with fixed joint deformities.…”

Error in the Figure

“…In the Clinical Challenge titled, “Erosive Deforming Inflammatory Arthritis in a Patient With Cervical Adenocarcinoma,” which published online September 26, 2019, the arrowheads were missing from the Figure panels. This article was corrected online.…”

Noncoding RNAs improve the predictive power of network medicine

“…Also, patients with RA have a higher risk of developing diabetes type I ( 79 ) due to insulin resistance, and patients with RA often develop diabetes mellitus ( 80 ); additionally, patients with asthma have higher risk of developing RA ( 81 , 82 ). Moreover, patients with RA have reported higher rates of heart failure ( 83 , 84 ), such as myocardial infarction ( 83 ) and stroke ( 84 ) in addition to atherosclerosis ( 85 ). Higher risk of multiple neoplasms has also been reported in patients with RA treated with anti-TNF drugs ( 86 , 87 ), interestingly, even though multiple myeloma and colonic neoplasms ( 88 ) share the same network neighborhood, they have reported decreased risk in patients with RA ( 89 ), suggesting that two diseases in the same network vicinity might also grant protection from each other.…”