{
  "abstract": "Objectives To explore the prevalence and distribution of ultrasound-detected inflammation and structural damage in the joints, tendons and entheses of patients who developed new-onset arthritis or arthralgia following exposure to immune checkpoint inhibitor (ICI) therapy, including a comparison between those with ICI-induced arthritis and those with ICI-induced arthralgia.Methods Patients with cancer who developed clinical arthritis or arthralgia (ie, joint pain without clinical synovitis) after receiving ICIs were consecutively recruited from six international centres. Patients underwent a full clinical assessment and ultrasound evaluation of 18 joints, 15 tendons and 5 entheses bilaterally, using the Outcome Measures in Rheumatology definitions.Results A total of 101 patients were included: 53 (52.5%) had ICI-arthralgia (absent clinical synovitis). Among them, 25 (47.2%) had ultrasound-detected subclinical synovitis, 10 (18.9%) tenosynovitis, 1 (1.9%) digital extensor peritendinitis and 13 (24.5%) enthesitis. In the 48 patients with ICI-arthritis, ultrasound-detected synovitis was more prevalent than in ICI-arthralgia (93.8% vs 47.2%, p<0.001), particularly in the wrists (56.3% vs 20.8%, p<0.001) and the knees (54.2% vs 13.2%, p<0.001), which were the most frequently affected joints. Tenosynovitis (52.1% vs 18.9%, p<0.001), peritendinitis (10.4% vs 1.9%, p=0.099) and bone erosions (25% vs 7.5%, p=0.027) were also more frequent in ICI-arthritis. ‘Active’ enthesitis was similar between groups (31.3% vs 24.5%), with no significant differences.Conclusions This multicentre study reveals a higher burden of ultrasound-detected changes in ICI-arthritis compared with ICI-arthralgia, with diverse patterns across joints, tendons and entheses in both subtypes. Significant subclinical inflammation suggests that many cases of non-specific ICI-arthralgia may benefit from targeted interventions.",
  "authors": [
    {
      "affiliations": [
        "Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK",
        "Department of Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK"
      ],
      "name": "Andrea Di Matteo"
    },
    {
      "affiliations": [
        "Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK",
        "Department of Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK"
      ],
      "name": "Kate Harnden"
    },
    {
      "affiliations": [
        "Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK",
        "Department of Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK",
        "NIHR Leeds Musculoskeletal Biomedical Research Unit, LIRMM, Leeds, UK",
        "Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK"
      ],
      "name": "Sana Sharrack"
    },
    {
      "affiliations": [
        "Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"
      ],
      "name": "Kerem Abacar"
    },
    {
      "affiliations": [
        "Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"
      ],
      "name": "Didem Sahin"
    },
    {
      "affiliations": [
        "Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine School of Medicine, Osaka, Japan"
      ],
      "name": "Tadashi Okano"
    },
    {
      "affiliations": [
        "Department of Paediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic"
      ],
      "name": "Rudolf Horvath"
    },
    {
      "affiliations": [
        "Department of Paediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic"
      ],
      "name": "Jana Hurnakova"
    },
    {
      "affiliations": [
        "Department of Rheumatology, School of Health Sciences, University of Ioannina Faculty of Medicine, Ioannina, Greece"
      ],
      "name": "Paraskevi V Voulgari"
    },
    {
      "affiliations": [
        "Department of Medical Oncology, University of Ioannina Faculty of Medicine, Ioannina, Greece"
      ],
      "name": "Melina Yerolatsite"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Juan José de Agustín"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Ernesto Trallero-Araguás"
    },
    {
      "affiliations": [
        "Internal Medicine, Ospedale Provinciale Madonna del Soccorso, San Benedetto del Tronto, Marche, Italy"
      ],
      "name": "Luca Di Geso"
    },
    {
      "affiliations": [
        "Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK",
        "Department of Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK",
        "NIHR Leeds Musculoskeletal Biomedical Research Unit, LIRMM, Leeds, UK"
      ],
      "name": "Richard J Wakefield"
    },
    {
      "affiliations": [
        "Clinica Reumatologica, Universita Politecnica delle Marche, Jesi, Italy"
      ],
      "name": "Emilio Filippucci"
    },
    {
      "affiliations": [
        "Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK",
        "Department of Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK",
        "NIHR Leeds Musculoskeletal Biomedical Research Unit, LIRMM, Leeds, UK"
      ],
      "name": "Paul Emery"
    },
    {
      "affiliations": [
        "Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK",
        "Department of Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK",
        "NIHR Leeds Musculoskeletal Biomedical Research Unit, LIRMM, Leeds, UK"
      ],
      "name": "Kulveer Mankia"
    }
  ],
  "title": "Ultrasound-detected inflammation and structural changes in the joints, tendons and entheses of patients with cancer who developed arthritis or arthralgia after exposure to immune checkpoint inhibitors",
  "uid": "7d3ebbdf-8f74-5c03-842d-9bf284f98df7"
}