Nivolumab-induced new-onset seronegative rheumatoid arthritis in a patient with advanced metastatic melanoma: A case report and literature review

Haikal, Ammar; Borba, Eduardo F.; Khaja, Taqui; Doolittle, Gary C.; Schmidt, Paul

doi:10.4103/ajm.ajm_127_17

Cited by 18 publications

(9 citation statements)

References 15 publications

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“…Arthralgia and myalgia are the most frequent musculoskeletal (MSK) irAEs and have been reported up to 40% in clinical trials [13–15]. However, severe immune-mediated arthritis is rare and has been described in the literature in the form of case reports and case series [13, 14, 16–21].…”

Section: Discussionmentioning

confidence: 99%

A Case of Severe Seronegative Inflammatory Arthritis due to Nivolumab and Review of the Literature

Thapa

Ali

Nair

et al. 2019

Case Reports in Rheumatology

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Immune-checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer, yet therapy is often hampered by immune-related adverse events (irAEs) which range from mild to severe life-threatening events. Musculoskeletal (MSK) irAEs leading to discontinuation of ICIs are uncommon but increasingly recognized. We report a challenging case of severe immune-related seronegative inflammatory arthritis due to nivolumab in a patient with stage IV metastatic adenocarcinoma.

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Section: Discussionmentioning

confidence: 99%

A Case of Severe Seronegative Inflammatory Arthritis due to Nivolumab and Review of the Literature

Thapa

Ali

Nair

et al. 2019

Case Reports in Rheumatology

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“…As in our case, IA is characterized by small-joint involvement of the metacarpophalangeal joint, proximal interphalangeal joint, the wrist, knee, and feet[ 4 ]. Rheumatoid factor and anti-citrullinated peptide antibody levels are usually normal[ 9 ]. Another relatively rare phenotype closely resembles that of spinal arthritis, which is characterized by large joint involvement, such as inflammatory back pain, adhesion point inflammation, and phalangitis[ 10 - 12 ].…”

Section: Discussionmentioning

confidence: 99%

Immune checkpoint inhibitor-associated arthritis in advanced pulmonary adenocarcinoma: A case report

Yan¹,

Huang²

2022

World J Clin Cases

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BACKGROUND With the wide application of immune checkpoint inhibitors (ICIs) in cancer treatment, immune-related adverse events occur frequently, involving almost all organs and systems. The incidence of ICI-associated arthritis (IA) is unknown. In most cases, IA is not serious and non-lethal. Higher checkpoint inhibitor arthritis disease activity may be associated with cancer progression. Here, we report a severe case of IA with high arthritis disease activity in advanced pulmonary adenocarcinoma, causing permanent withdrawal of pembrolizumab, but the patient remained in complete remission (CR) 20 mo after the development of IA. CASE SUMMARY An 81-year-old smoking man was admitted to our hospital because of left chest pain for 9 mo. He was finally diagnosed with advanced pulmonary adenocarcinoma, with programmed cell death 1 ligand 1 expression of 70%. The patient responded to pembrolizumab treatment and achieved CR, but IA occurred after the 5 th cycle of pembrolizumab administration. Although non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs were prescribed, arthralgia and joint swelling occurred. The symptoms of arthritis were further aggravated when immunotherapy was given again after short-term withdrawal. Clinical Disease Activity Index (CDAI) score, a traditional measure of arthritis activity, was 43. Intravenous methylprednisolone was prescribed at 20 mg/d and then tapered over the subsequent 4 wk. The symptoms of arthritis steadily improved and completely resolved 4 mo after withdrawal of pembrolizumab. A recent follow-up in June 2022 revealed satisfactory clinical recovery of arthritis and the patient remained in CR. CONCLUSION This case report highlights that early recognition of IA and appropriate treatment are critical to improving the outcome of both ICI-arthritis and lung cancer.

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“…17 Most patients with inflammatory arthritis from ICIs were negative for rheumatoid factor and anticyclic citrullinated peptide antibodies traditionally associated with rheumatoid arthritis. 18 Treatment of inflammatory arthritis included nonsteroidal anti-inflammatory drugs (NSAIDs), prednisone, and both nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs). 19 Hematological irAEs, including autoimmune hemolytic anemia, immune thrombocytopenia, neutropenia and aplastic anemia, are rarely reported.…”

Section: Toxicity Profilementioning

confidence: 99%

Management of immune checkpoint inhibitor‐related adverse events: A review of case reports

Song

et al. 2020

Thoracic Cancer

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Immune checkpoint inhibitors represent a major breakthrough in cancer therapy. Immune‐related adverse events (irAEs) may occur during treatment due to their unique mechanism of action. Management of irAEs is based on clinical experience because it is not easy to conduct prospective trials to evaluate the best treatment strategy. Using a combination of search terms in the PubMed and Embase databases, we reviewed all cases in the English language citing toxicities associated with either pembrolizumab, nivolumab, ipilimumab, atezolizumab, tremelimumab, durvalumab, avelumab or any combination of these agents published before 20 May 2019. A total of 128 reports with 239 cases were included in the study. Here, we summarize the spectrum of toxicities, safety in special patients, rechallenging after irAEs and agents used for treatment of irAEs in those reports.

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Nivolumab-induced new-onset seronegative rheumatoid arthritis in a patient with advanced metastatic melanoma: A case report and literature review

Abstract: Immune-related adverse events have been reported in patients treated with anti-programmed death-1 receptor drugs such as nivolumab. We present a case of a new-onset seronegative rheumatoid arthritis in a patient with metastatic melanoma treated with nivolumab.

Cited by 18 publications

References 15 publications

A Case of Severe Seronegative Inflammatory Arthritis due to Nivolumab and Review of the Literature

A Case of Severe Seronegative Inflammatory Arthritis due to Nivolumab and Review of the Literature

Immune checkpoint inhibitor-associated arthritis in advanced pulmonary adenocarcinoma: A case report

Management of immune checkpoint inhibitor‐related adverse events: A review of case reports

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