Patients with checkpoint inhibitor‐induced inflammatory arthritis do not become seropositive for anti‐cyclic citrullinated peptide when followed over time

Cappelli, Laura C.; Darrah, Erika; Shah, Ami A.; Bingham, Clifton O.

doi:10.1002/acr2.11363

Cited by 6 publications

(3 citation statements)

References 6 publications

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“… 27 Patients with ICI-arthritis who are seronegative at presentation have been shown not to seroconvert over time. 28 It is unknown whether the natural history of ICI-arthritis differs in those who are seropositive vs seronegative either in terms of disease severity or disease duration, and the absence of antibody positivity should not stand in the way of ICI-arthritis treatment.…”

Section: Patient Assessmentmentioning

confidence: 99%

Monitoring and Management of the Patient with Immune Checkpoint Inhibitor-Induced Inflammatory Arthritis: Current Perspectives

Chan¹,

Bass²

2022

JIR

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In this review, we draw from observational studies, treatment guidelines and our own clinical experience to describe approaches to monitoring and management of immune checkpoint inhibitor (ICI)-induced inflammatory arthritis, including polymyalgia rheumatica. This condition occurs in about 4% of ICI-treated cancer patients and can persist for a year or longer. Mild arthritis can generally be managed with non-steroidal anti-inflammatory drugs, intraarticular steroids injections and/or low dose corticosteroids. Higher grade arthritis should be brought under control with corticosteroids, but early introduction of a steroid-sparing agent is recommended to minimize steroid toxicity. In order to assess the effectiveness of any arthritis treatment, tender and swollen joint counts and patient reported measures of physical function, such as the health assessment questionnaire, should be obtained at each visit. Referral to a rheumatologist is recommended for patients with high grade arthritis to help guide the use of disease-modifying antirheumatic drugs.

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Section: Patient Assessmentmentioning

confidence: 99%

Monitoring and Management of the Patient with Immune Checkpoint Inhibitor-Induced Inflammatory Arthritis: Current Perspectives

Chan¹,

Bass²

2022

JIR

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“…В качестве модели представляет интерес развитие серонегативного РА-подобного артрита у пациентов, получающих терапию ингибиторами иммунных контрольных точек (ИКТ) по поводу злокачественных новообразований [178,179], у которых наряду с синовитом, теносиновитом, эрозиями суставов отмечено развитие Научно-практическая ревматология. 2023;61(3):276-291 энтезита, энтезопатии, аксиального воспаления и псориатического поражения кожи, характерных для СпА [180][181][182][183][184]. В сыворотках пациентов были обнаружены анти-РA33 [185], которые, как уже отмечалось, выявляются у пациентов с серонегативным РА [89].…”

Section: Discussionunclassified

Rheumatoid arthritis as a clinical and immunological syndrome: focus on the seronegative subtype of the disease

Насонов

Авдеева²,

Dibrov³

2023

Naučno-praktičeskaâ revmatologiâ

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Rheumatoid arthritis (RA) is the most common immune mediated (autoimmune) rheumatic disease, manifested by chronic erosive arthritis and systemic internal organ damage. Currently, RA is considered as a syndrome characterized by clinical and pathogenetic heterogeneity associated with a variety of mechanisms of pathological activation of innate and acquired immunity, determining the variability of the course and outcome of the inflammatory process and effectiveness of therapy. Based on the detection or absence of rheumatoid factor (RF) IgM and antibodies to cyclic citrullinated peptides (ACCP), RA can be conventionally divided into two subtypes (phenotypes): seropositive RA and seronegative RA, but thanks to improvement of laboratory diagnostic methods the spectrum of autoantibodies detected in RA has increased significantly. Diagnosis of seronegative RA based on classification (rather than diagnostic) criteria can be difficult, especially in the early stages of the disease, and the diagnosis is made only during long-term follow-up of patients. It complicates the timely prescription of adequate anti-inflammatory therapy. This article summarizes the data on genetic predisposition, immunopathogenesis, biomarkers, clinical spectrum, instrumental diagnosis and pharmacotherapy of seronegative RA.

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“… 14 Although the RA33 antigen can be targeted in its native or citrullinated form, antibodies that prefer the native form of hnRNP A2/B1 have been detected in early RA and in patients with low erosion scores on imaging. 15 The presence of anti-RA33 antibodies targeting the native antigen in early IA and the paucity of antibodies to citrullinated antigens in patients with ICI-induced IA 16 led us to hypothesise that antibodies to the native RA33 antigen could be present in ICI-induced IA.…”

Section: Introductionmentioning

confidence: 99%

Anti-RA33 antibodies are present in a subset of patients with immune checkpoint inhibitor-induced inflammatory arthritis

Cappelli¹,

Bingham²,

Forde³

et al. 2022

RMD Open

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ObjectivePatients with inflammatory arthritis (IA) associated with immune checkpoint inhibitor (ICI) treatment for cancer are typically seronegative for anti-cyclic citrullinated peptide (CCP) antibodies and rheumatoid factor, but little is known about the presence of other autoantibodies in this patient population. We investigated the prevalence and characteristics of anti-RA33 antibodies in patients with ICI-induced IA.MethodsAnti-RA33 ELISAs were performed on sera from four groups of patients: 79 with ICI-induced IA, 52 with rheumatoid arthritis (RA), 35 treated with ICIs without IA during follow-up and 50 healthy controls. Anti-RA33 positivity and level, clinical and demographic data were compared across groups.ResultsAnti-RA33 antibodies were found in 9/79 (11.4%) patients with ICI-induced IA but in 0/35 patients treated with ICIs who did not develop IA (0%; p=0.04). Of the patients positive for anti-RA33, two had sera available from before ICI treatment; anti-RA33 antibodies were present in both pre-ICI treatments. In patients with RA, 7.7% were positive for anti-RA33 antibodies as were 2% of healthy controls. In ICI-induced IA, anti-RA33 antibodies were associated with anti-CCP antibodies (p=0.001). We found no statistically significant differences in other clinical characteristics in those with and without anti-RA33 antibodies.ConclusionsAnti-RA33 antibodies are present in a subset of patients with ICI-induced IA, absent in other ICI-treated patients and may be a biomarker for developing IA. Additional studies evaluating serial samples before and after ICI treatment will further establish the temporal relationship of these antibodies to IA development.

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Patients with checkpoint inhibitor‐induced inflammatory arthritis do not become seropositive for anti‐cyclic citrullinated peptide when followed over time

Cited by 6 publications

References 6 publications

Monitoring and Management of the Patient with Immune Checkpoint Inhibitor-Induced Inflammatory Arthritis: Current Perspectives

Monitoring and Management of the Patient with Immune Checkpoint Inhibitor-Induced Inflammatory Arthritis: Current Perspectives

Rheumatoid arthritis as a clinical and immunological syndrome: focus on the seronegative subtype of the disease

Anti-RA33 antibodies are present in a subset of patients with immune checkpoint inhibitor-induced inflammatory arthritis

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