The Current and Future of Biomarkers of Immune-related Adverse Effects
With their groundbreaking clinical responses, immune checkpoint inhibitors (ICIs) have ushered in a new chapter in cancer therapeutics. However, they are often associated with life-threatening or organ-threatening autoimmune/autoinflammatory phenomena, collectively termed immune-related adverse events (irAEs). In this review, we will first describe the mechanisms of action of ICIs as well as irAEs. Next, we will review biomarkers for predicting the development of irAEs or stratifying risks. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - March 12, 2024 Category: Rheumatology Authors: William Bracamonte-Baran, Sang T. Kim Source Type: research

Myositis
induced by immune checkpoint inhibitors (ICIs) is an infrequent, potentially fatal, immune-related adverse event. It has higher incidence in patients who receive combination ICI therapy compared to monotherapy. Patients can present with clinical manifestation symptoms of myositis alone or in combination with myocarditis and/or myasthenia gravis, which significantly worsens the course and prognosis. Diagnosis can generally be made on the basis of clinical presentation, elevation of muscle enzymes, and electromyographic changes, but some patients may require a muscle biopsy. The first line of therapy is high-dose corticoste...
Source: Rheumatic Disease Clinics of North America - March 12, 2024 Category: Rheumatology Authors: Athira Jayan, Andrew L. Mammen, Maria E. Suarez-Almazor Source Type: research

The Need for Classification Criteria of Immune Checkpoint Inhibitor-Induced Inflammatory Arthritis
Immune checkpoint inhibitor-induced inflammatory arthritis (ICI-IA) is an immune-related adverse event that can occur as a result of receiving ICIs for cancer treatment. Thus far, ICI-IA has been described variably in the literature, in part due to varying presentations that evolve over time, as well as a lack of standardized definitions and classification. This scoping review aggregates various descriptions of ICI-IA, highlighting the most prominent attributes of ICI-IA from categories such as symptoms, signs, imaging, and laboratory findings as well as discussing potential mimic conditions. (Source: Rheumatic Disease Cli...
Source: Rheumatic Disease Clinics of North America - March 12, 2024 Category: Rheumatology Authors: Nilasha Ghosh, Bridget Jivanelli, Nina Couette, Namrata Singh, Marie Kostine, Alexa Meara, David F.L. Liew Source Type: research

Inflammatory Arthritis due to Immune Checkpoint Inhibitors
The introduction of immune checkpoint inhibitors (ICIs) has changed the landscape of the treatment of cancer. Several immune-related adverse events (irAEs) have now been described such as ICI-inflammatory arthritis (IA), sicca syndrome, polymyalgia rheumatica, myositis, and vasculitis as a consequence of immune activation. The onset of the ICI-IA can vary from after the first infusion of ICIs to a delayed presentation a year or more after ICI initiation. Ultimately, baseline patient and tumor characteristics, the types of immunotherapies used, pre-existing autoimmune diseases, and/or other irAEs, as well as patient prefere...
Source: Rheumatic Disease Clinics of North America - March 7, 2024 Category: Rheumatology Authors: Namrata Singh, Anupama Shahane, Jeffrey A. Sparks, Samuel Bitoun, Laura C. Cappelli Source Type: research

Imaging in Rheumatic Immune-Related Adverse Events
Since their introduction, immune checkpoint inhibitors have revolutionized cancer treatment by harnessing the body ’s own immune system as a defense against tumor growth. The downside of activating the immune system is the development of immune-related adverse events (irAEs), which mimic autoimmune disease of various organ systems. The musculoskeletal system is an uncommon, but substantial one for patients and can lead to long-term pain and disability that affects their quality of life. This review summarizes recent literature on imaging forms utilized for diagnosis and assessing treatment response in rheumatic irAEs. (S...
Source: Rheumatic Disease Clinics of North America - March 7, 2024 Category: Rheumatology Authors: Jeremy Zhang, Ruoning Ni, Ibiyemi Oke, Cassandra Calabrese, Jennifer Strouse, Sophia Weinmann, Alexandra Ladouceur Source Type: research

Impact of Nonsteroidal Anti-inflammatory Drugs, Glucocorticoids, and Disease-Modifying Antirheumatic Drugs on Cancer Response to Immune Checkpoint Inhibitor Therapy
Immune checkpoint inhibitor (ICI) therapy for advanced malignancies often leads to off-target adverse events. Rheumatic immune-related adverse events can often linger beyond the duration of ICI therapy and sometimes requires the use of immunomodulator therapy. A key question, therefore, is if the commonly used therapies affect cancer outcomes. In this review, the authors summarize the state of the data as it currently stands, taking into consideration the limitations of the various source studies. The most information is known about glucocorticoids, which appear to be harmful especially when used early and at high doses. (...
Source: Rheumatic Disease Clinics of North America - March 7, 2024 Category: Rheumatology Authors: Karmela K. Chan, Anne R. Bass Source Type: research

Mimickers of Inflammatory Arthritis Induced by Checkpoint Inhibitors
The differential diagnosis of inflammatory arthritis as an immune-related adverse event can be challenging as patients with cancer can present with musculoskeletal symptoms that can mimic arthritis because of localized or generalized joint pain. In addition, immune checkpoint inhibitors can exacerbate joint conditions such as crystal-induced arthritis or osteoarthritis, or induce systemic disease that can affect the joints such as sarcoidosis. This distinction is important as the treatment of these conditions can be different from that of immune-related inflammatory arthritis. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - March 5, 2024 Category: Rheumatology Authors: Jos é A. Gómez-Puerta, Karolina Gente, Tamiko R. Katsumoto, Jan Leipe, Pankti Reid, Wouter H. van Binsbergen, Maria E. Suarez-Almazor Source Type: research

Preexisting Autoimmune Diseases and Immune Checkpoint Inhibitors for Cancer Treatment: Considerations About Initiation, Flares, Immune-Related Adverse Events, and Cancer Progression
Immune checkpoint inhibitors (ICIs) are increasingly used to treat a variety of cancer types. Patients with preexisting autoimmune diseases may be vulnerable to underlying disease flare as well as immune-related adverse events from ICIs. There has also been concern that immunosuppression needed to control the autoimmune disease may blunt ICI efficacy. Much of the literature is focused on diverse preexisting autoimmune diseases, which may limit conclusions to specific diseases. There is a growing literature of specific diseases, such as preexisting rheumatoid arthritis, investigating outcomes after ICI. (Source: Rheumatic D...
Source: Rheumatic Disease Clinics of North America - February 23, 2024 Category: Rheumatology Authors: Jeffrey A. Sparks Source Type: research

De Novo Connective Tissue Disorders as Immune-Related Adverse Events
Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment through blocking immunoregulatory pathways, resulting in augmented antitumor responses. However, ICIs can cause inflammatory autoimmune toxicities, known as immune-related adverse events (irAEs). Common rheumatic irAEs include inflammatory arthritis, polymyalgia rheumatica-like symptoms, and myositis. Fewer cases of de novo connective tissue disease as irAEs have been described and have mainly presented with cutaneous manifestations of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). Treatments include glucocorticoids and steroid-spari...
Source: Rheumatic Disease Clinics of North America - February 23, 2024 Category: Rheumatology Authors: Lindsay Kristin Cho, Shahin Jamal Source Type: research

Rheumatic Immune-Related Adverse Events: Current Clinical Imperatives Underpin Future Novel Insights
The highly heralded immune checkpoint inhibitor immunotherapy revolution not just has revolutionized cancer but also is making waves in the medical world around it. The price, however, of dramatically improved cancer outcomes and the immune activation that facilitates them is a burden of inflammatory sequelae that cancer immunotherapy patients, their treating oncologists, and the physicians from other disciplines who help them have had to learn to navigate. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - February 23, 2024 Category: Rheumatology Authors: David F.L. Liew, Alexa Simon Meara Tags: Preface Source Type: research

The Utility of Laboratory Investigations for the Assessment and Management of Rheumatic Immune-Related Adverse Events
This article summarizes the latest evidence regarding the utility of laboratory investigations in Rh-irAEs. (Source: Rheumatic Disease Clinics of North America)
Source: Rheumatic Disease Clinics of North America - February 22, 2024 Category: Rheumatology Authors: Alexandra Ladouceur, Aiarpi Ezdoglian, Jeffrey A. Sparks, Marie Hudson, Shahin Jamal, Alison Clifford, Janet Roberts, Carrie Ye Source Type: research

Patient Voices in Rheumatic Immune-Related Adverse Events
Patients with cancer considering immune checkpoint inhibitor (ICI) therapy often look for health information and peer support through online communities. The authors used social media content analysis to obtain the perspectives of patients receiving ICI treatment about immune-related adverse events (irAEs), with particular focus on rheumatological symptoms. The most reported rheumatic symptom was joint pain. Other commonly reported symptoms included muscle pain, joint stiffness, arthritis, myositis, bone pain, back pain, and tendon/ligament pain. A few users reported development of rheumatic diseases. The authors ’ analy...
Source: Rheumatic Disease Clinics of North America - February 22, 2024 Category: Rheumatology Authors: Kara N. Corps, Oliver Terry, Maria A. Lopez-Olivo Source Type: research

Immunotherapy Toxicity Management in Clinical Practice
Cancer immunotherapy is revolutionary for survival but has complications due to immunogenicity with unpredictable and potentially long-lasting autoimmune side effects known as immune-related adverse events (irAEs). Currently, treatment beyond corticosteroids can be complicated by the diversity of providers who are needed across a variety of clinical settings to manage irAEs. We outline the role of critical players in the management of irAEs, discuss the current limitations that exist, and propose various methodologies that can be adapted across clinical settings to tackle these needs. We aim to better understand who can be...
Source: Rheumatic Disease Clinics of North America - February 13, 2024 Category: Rheumatology Authors: Yael Klionsky, Alexa Meara, Pankti Reid Source Type: research

Lessons from Carl M. Pearson 1919 – 1981
Carl M. Pearson was an energetic and exceptional physician –scholar-leader who founded, established, and broadened the Divisions of Rheumatology at University of California in Los Angeles (UCLA) beginning in 1956. His studies to induce myositis by injecting muscle saturated with the heat-killed tubercle bacillus, an emulsifier, and mineral oil (Freund’s adjuvant) enabled his report that polyarthritis occurred with Freund’s adjuvant alone in certain strains of rat and mice. This model of adjuvant arthritis allowed the next generation of studies to assess therapies for autoimmune diseases. (Source: Rheumatic Disease Cl...
Source: Rheumatic Disease Clinics of North America - November 15, 2023 Category: Rheumatology Authors: James S. Louie Source Type: research

Charles L Christian
Dr Charles L Christian arrived in New York City in 1953, having grown up in Wichita, Kansas, and graduating from medical school at Case Western Reserve in Cleveland, Ohio. In New York, Dr Christian embarked on training in internal medicine at Columbia ’s Presbyterian Hospital where he met an individual who would shape the course of his career, Dr Charles Ragan, a founder of the Arthritis Foundation. Dr Christian, or Chuck as he was usually called, went on to shape the developing field of rheumatology, advancing understanding of our most complex diseases as an investigator, master clinician, mentor, and academic leader. D...
Source: Rheumatic Disease Clinics of North America - November 15, 2023 Category: Rheumatology Authors: Mary K. Crow, Josef S. Smolen Source Type: research