MRI May Help Differentiate Checkpoint Inhibitor-induced Arthritis, Other Joint Pain
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MRI imaging may help physicians distinguish between inflammatory arthritis caused by immune checkpoint inhibitors from other joint pain, and aid in identifying patients who are at an increased risk for joint damage, according to data published in JAMA Network Open.
“Use of checkpoint inhibitors has changed the landscape of cancer therapy, but also led to the emergence of immune-related adverse events like ICI-induced inflammatory arthritis,” Sarthak Gupta, MD, of the NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases, told Healio Rheumatology. “There is need for a reproducible, reliable and accessible modality to assess and distinguish early checkpoint inhibitor-induced inflammatory arthritis and help in management.”
Gupta and colleagues conducted a retrospective case series of eight patients at the NIH Clinical Center in Bethesda, Maryland to analyze the role of joint MRI among individuals with inflammatory arthritis related to checkpoint therapy. All participants — six women and two men aged between 50 and 65 years — had been enrolled in various institutional review board-approved protocols for immune checkpoint inhibitors, had developed joint-related symptoms, and had MRI data available for at least one joint. Just one patient was receiving combined checkpoint therapy.
Rheumatologists assessed the patients were assessed between Dec. 27, 2016, and May 28, 2019, with a retrospective health record review performed to identify demographic and clinical characteristics of inflammatory arthritis, as well as malignant tumors and imaging findings. Thirteen separate MRI examinations were reviewed for synovitis, tenosynovitis, bone marrow edema and soft tissue conditions.
Investigators noted that tenosynovitis and synovitis were often seen in the hands and wrists. They also reported that three patients demonstrated bone marrow edema and erosions, suggesting early damage. In larger joints, such as the knees and ankles, joint effusions and synovial thickening were characteristic. Five patients were treated with corticosteroids and demonstrated good responses. Among those with high-risk features observed in the MRI, such as bone marrow edema and erosions, DMARDs were also discussed as a treatment option.
“Our findings suggest that MRI of joints may be helpful for early diagnosis, guiding therapeutic decisions and identifying patients at high risk for developing erosive disease,” Gupta told Healio Rheumatology.
The researchers noted that these findings support the role of MRI in assessing ICI-induced symptoms, and more widespread use of MRI in guiding medical decision-making regarding management of ICI-induced inflammatory arthritis.
“A prospective study of MRI may be fruitful for understanding the pathophysiological processes and long-term clinical implications of this entity,” Gupta and colleagues wrote. “Quantitative measurements through MRI in future studies could potentially help standardize the grading of this adverse event to guide treatment stratification, prevent prolonged exposure to high-dose systemic steroids, and allow early resumption of anticancer therapy.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Linda Grinnell-Merrick, MS, NP-BC
Immune checkpoint inhibitors have made a significant impact on the treatment of cancers. With this treatment, as with many other medical treatments, comes adverse side effects. We now have a new category of inflammatory arthritis characterized as ICI-induced inflammatory arthritis.
It is always a little unsettling when we receive these referrals from oncology; here are patients with cancers requiring therapy and now possibly a new disease process. But is it truly an inflammatory arthritis and how best to diagnose? We have relied on physical exam and history, at times ultrasound, not available at all rheumatology practices, and now with this small study it seems that MRI can help in identifying early inflammatory arthritis thus establishing early treatment for these patients.
I certainly read this with interest and will keep this in mind when we have patients referred to us for probable ICI-induced inflammatory arthritis. I look forward to more studies on ICI-induced inflammatory arthritis in the future as we have more patients receiving these treatments.
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