PT  - JOURNAL ARTICLE
AU  - Rakiba Belkhir
AU  - Sébastien Le Burel
AU  - Laetitia Dunogeant
AU  - Aurélien Marabelle
AU  - Antoine Hollebecque
AU  - Benjamin Besse
AU  - Alexandra Leary
AU  - Anne-Laure Voisin
AU  - Clémence Pontoizeau
AU  - Laetitia Coutte
AU  - Edouard Pertuiset
AU  - Gaël Mouterde
AU  - Olivier Fain
AU  - Olivier Lambotte
AU  - Xavier Mariette
TI  - Rheumatoid arthritis and polymyalgia rheumatica occurring after immune checkpoint inhibitor treatment
AID  - 10.1136/annrheumdis-2017-211216
DP  - 2017 Oct 01
TA  - Annals of the Rheumatic Diseases
PG  - 1747--1750
VI  - 76
IP  - 10
4099  - http://ard.bmj.com/content/76/10/1747.short
4100  - http://ard.bmj.com/content/76/10/1747.full
SO  - Ann Rheum Dis2017 Oct 01; 76
AB  - Objectives Immune checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte-associated protein 4 and programmed cell death protein 1 (PD-1) have demonstrated improved survival for multiple cancers. However, these new drug classes have led to increased immune-related adverse events (IrAE). Rheumatic IrAEs have not been well described in clinical trials. We report here cases of rheumatoid arthritis (RA) and polymyalgia rheumatica (PMR) occurring after ICI treatment.Methods This was a retrospective study of patients receiving an ICI in whom symptoms of arthritis or arthralgia developed and revealed a diagnosis of RA or PMR.Results In 10 patients who received ICI therapy (all anti-PD-1 or anti-PDL1 antibodies), RA or PMR developed at a median of 1 month (1 to 9) after exposure. No patient had pre-existing rheumatic or autoimmune disease. RA developed in six patients; all six were positive for anti-cyclic citrullinated peptide (anti-CCP) antibodies and four for rheumatoid factor. Anti-CCP antibodies were detected in two out of three patients tested before immunotherapy. Disease-modifying antirheumatic drugs were needed for three patients; the three others received corticosteroids or non-steroid anti-inflammatory drugs. PMR was diagnosed in four patients, all responded to corticosteroids. Despite these IrAEs, immunotherapy was pursued for all but one patient until cancer progression.Conclusions This is the first description of RA occurring after ICI therapy for cancer. PMR can also occur after ICI, particularly after anti-PD-1 therapy. All cases responded to corticosteroids or with immunosuppressive therapy. Collaboration between rheumatologists and oncologists is crucial and could lead to better recognition and care of these patients.