Rheumatologic toxicities arising from ICI therapy are increasingly recognized and are more often associated with symptoms that persist after cessation of immunotherapy. Personal (25%) or family (10%) history of autoimmune disorders are associated with increased predisposition to rheumatologic irAEs. Diagnosis can be challenging due to the broad range of symptoms, lack of traditional clinical presentation, and majority of knowledge based on small number of patients presented as case reports in the literature. Arthralgia, joint and muscle pain, presents one of the most common symptoms occurring in 10% to 15% of patients. Clinical assessment includes full medical and family history, exam of joints and muscle strength, diagnostic imaging, serum testing and rule out other underlying medical conditions. While rheumatological irAEs are rarely life-threatening, prompt referral to a rheumatologist is essential as delayed treatment can lead to long-term disability, chronic disorders and may require permanent immunosuppressive therapy. Immunotherapy can continue in low grade rheumatologic irAEs but is often delayed or discontinued with persistent and/or high grade (> 3) symptoms.
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