{
  "abstract": "Background Immune checkpoint inhibitor (ICI)-related inflammatory arthritis occurs in approximately 6% of ICI-treated patients, and is often long-lasting. The clinical presentation is heterogeneous, and often loosely resembles either rheumatoid arthritis (ICI-IA) with peripheral presentation, or polymyalgia rheumatica (ICI-PMR) with predominant bilateral shoulder and hip pain and stiffness. Our objective was to compare clinical features, immunosuppressive treatment, and cancer outcomes between ICI-IA and ICI-PMR.Methods Data were extracted from the Rheumatology Adverse Events Due to Immunotherapy Observational Study multicenter prospective registry, regarding patients with rheumatologist-diagnosed ICI-IA or ICI-PMR and no preexisting primary IA/PMR. Clinical features were collected at the first visit in the registry. Multivariable logistic regression was used to compare second-line immunosuppressive drug utilization between groups. Kaplan-Meier curves were constructed to compare time of prednisone tapering to a dose of (1) 10 mg and (2) 5 mg from the baseline registry visit. Cox proportional hazard models were used to compare progression-free survival (PFS). Date of first cancer progression from arthritis onset was extracted based on documentation of imaging and/or pathology in the medical record. Patients with ICI-PMR were also compared with an independent cohort of patients with primary PMR.Results We analyzed 490 patients: 418 with ICI-IA and 72 with ICI-PMR. Compared with patients with ICI-IA, patients with ICI-PMR were older (70 vs 63 years old, p<0.001), more likely to be male (p=0.034), had shorter onset after ICI initiation (87 vs 125 days, p=0.011) and had less peripheral synovitis (15% vs 72%, p<0.001). Time to a prednisone dose of 10 and 5 mg/day was comparable between groups. Patients with ICI-IA were more likely to receive a second-line immunosuppressive drug (OR 3.51 (95% CI 1.50 to 8.21, p=0.004)). PFS was comparable between groups. Compared with primary PMR (n=189), the sex ratio was inversed in ICI-PMR, but there was a similar proportion with peripheral arthritis (15%).Conclusions Patients with ICI-IA were more likely to require a second-line immunosuppressive drug than patients with ICI-PMR, but PFS was the same. Future therapeutic clinical trials in ICI-IA/PMR should stratify patients according to phenotype.",
  "authors": [
    {
      "affiliations": [
        "Department of Rheumatology, CHU de Brest, LBAI UMR1227, Univ Brest, Inserm, Brest, France",
        "Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA"
      ],
      "name": "Alice Tison"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA",
        "Department of Medicine, Weill Cornell Medicine, New York, New York, USA"
      ],
      "name": "Deanna Jannat-Khah"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA"
      ],
      "name": "Laura C Cappelli"
    },
    {
      "affiliations": [
        "Department of Health Services Research and Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA"
      ],
      "name": "Maria E Suarez-Almazor"
    },
    {
      "affiliations": [
        "Department of Cancer Sciences, Global Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA. Cancer Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE",
        "Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Department of Rheumatology & Rehabilitation, Assiut University Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt"
      ],
      "name": "Noha Abdel-Wahab"
    },
    {
      "affiliations": [
        "Department of Medicine, Section of Rheumatology, Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, Illinois, USA"
      ],
      "name": "Pankti Reid"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA",
        "Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Jeffrey A Sparks"
    },
    {
      "affiliations": [
        "The University of Utah, Salt Lake City, Utah, USA"
      ],
      "name": "Tawnie J Braaten"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Division of Oncology and Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA"
      ],
      "name": "Alexa Meara"
    },
    {
      "affiliations": [
        "Department of Rheumatologic and Immunologic Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA"
      ],
      "name": "Cassandra Calabrese"
    },
    {
      "affiliations": [
        "Department of Medicine Division of Immunology and Rheumatology, Stanford University, Palo Alto, California, USA"
      ],
      "name": "Tamiko Katsumoto"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA",
        "Department of Medicine, Weill Cornell Medicine, New York, New York, USA"
      ],
      "name": "Nilasha Ghosh"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA"
      ],
      "name": "Kyle Ge"
    },
    {
      "affiliations": [
        "Department of Rheumatology, CHU de Brest, LBAI UMR1227, Univ Brest, Inserm, Brest, France"
      ],
      "name": "Alain Saraux"
    },
    {
      "affiliations": [
        "Department of Rheumatology, CHU de Brest, LBAI UMR1227, Univ Brest, Inserm, Brest, France"
      ],
      "name": "Valérie Devauchelle-Pensec"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA"
      ],
      "name": "Ami A Shah"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA"
      ],
      "name": "Clifton O Bingham"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA",
        "Department of Medicine, Weill Cornell Medicine, New York, New York, USA"
      ],
      "name": "Anne R Bass"
    }
  ],
  "title": "Comparing immune-checkpoint inhibitor-mediated inflammatory arthritis to polymyalgia rheumatica: a prospective cohort study",
  "uid": "b52ef505-7858-5469-bb33-6c48d7f1fd19"
}