Jonathan S. Coblyn, MD reviewing Cappelli LC et al. Ann Rheum Dis 2017 Jan.

Inflammatory arthritis or sicca syndrome symptoms can develop after starting treatment with immune checkpoint inhibitors.

Immune checkpoint inhibitors (ICIs; e.g., ipilimumab [Yervoy], nivolumab [Opdivo], pembrolizumab [Keytruda]) increasingly are being used to treat advanced cancers. However, these agents have been associated with immune-related adverse events, including life-threatening pneumonitis and colitis, autoimmune thyroid disease, hypophysitis, and vitiligo.

Among about 700 patients who received ICIs at Johns Hopkins University, 13 developed inflammatory arthritis or sicca symptoms after starting therapy with ipilimumab or nivolumab. Nine patients presented with inflammatory arthritis, none of whom tested positive for rheumatoid factor or anti–cyclic citrullinated peptide antibodies. A rheumatoid arthritis (RA)–like syndrome developed in six of these patients, five of whom required high-dose steroids, and two of whom had continuing synovitis after stopping ICI therapy. The other four patients presented with sudden-onset sicca syndrome, including severe dry mouth with salivary hypofunction. Some patients in both groups developed additional immune-related adverse events (e.g., colitis, pneumonitis, interstitial nephritis), which resolved with steroid therapy. Almost all patients developed first events within 9 months of starting ICI therapy.

CITATION(S):

Cappelli LC et al. Inflammatory arthritis and sicca syndrome induced by nivolumab and ipilimumab. Ann Rheum Dis 2017 Jan; 76:43.

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