Case Report

A Case of Severe Seronegative Inflammatory Arthritis due to Nivolumab and Review of the Literature

Table 2

Summary of published case series or case report on rheumatologic/musculoskeletal immune-related adverse effects (irAEs).

Case series/report(s)Number of patientsImmune-checkpoint inhibitorPrimary malignancyPatternJoint involvementSymmetrical/AsymmetricalAxial/appendicularClinical diagnosisSerologyTherapySteroid dose (for arthritis patients only)ResponseICI status

Chan et al. [17]2Anti-PD1: 2Melanoma: 2Seronegative arthritis: 2Polyarthritis: 2NANoneInflammatory arthritisRF: −ve, anti-CCP: −ve, ANA: −veOpioid analgesics: 1, pamidronate, NSAIDs and DMARDs (sulfasalazine, HCQ): 1Steroid not usedImprovement: 2Continued: 1, held: 1
Law-Ping-Man et al. [22]1Anti-PD1NSCLCPsoriatic arthritisOligoarthritisAsymmetricalNoneInflammatory arthritisRF: −ve, anti-CCP: −ve, ANA: −veSteroid, DMARDs (MTX)Prednisone (15 mg/day)ImprovementContinued
Ruiz-Bañobre et al. [23]1Anti-PD1NSCLCPsoriatic arthritisPolyarthritisNANRInflammatory arthritisRF: −ve, anti-CCP: −ve, ANA: −veIA steroid, steroid, NSAIDs, DMARDS (MTX, sulfasalazine)Methylprednisone (4 mg/day)ImprovementContinued
Kim et al. [24]3Anti-PD1: 1, anti-PD1 and anti-CTLA-4: 2Melanoma: 3Seronegative arthritis: 3Polyarthritis: 3Symmetrical: 3NoneArthritisRF: −ve, anti-CCP Ab: −ve, ANA: 1Prednisone and anti-IL-6 Ab: 2, anti-IL-6 Ab (tocilizumab): 1Prednisone (40 mg/day)Improvement: 3NR
Kuswanto et al. [19]4Anti-PD1: 4RCC: 4Seronegative arthritis: 3, PMR: 1Polyarthritis: 3Symmetrical: 2Pelvic girdle: 1Inflammatory arthritisRF: NA, anti-CCP Ab: NA, ANA: NASteroid: 1, steroid and IA steroid: 1, steroid and DMARDs (MTX): 1, infliximab: 1Prednisone (50–20 mg/day)Improvement: 4Held: 3
Cappelli et al. [25]9Anti-PD1: 2, anti-PD1 and anti-CTLA-4: 7RCC: 1, small cell lung cancer: 1, melanoma: 3, NSCLC: 4Seronegative arthritis: 9Polyarthritis: 8, oligoarthritis: 1NRBack pain: 1Inflammatory arthritisRF: −ve, anti-CCP Ab: −ve, ANA: 1Prednisone: 1, dexamethasone: 1, NSAIDs and IA steroid: 1, prednisone and TNF alfa inhibitor: 2, prednisone, DMARDs (MTX, infliximab, etanercept) and IA steroid: 2, prednisone and IA steroid: 2Prednisone (40–10 mg/day), 120 mg for 1 patientImprovement: 7, partial response: 1, NR: 1NR
Calabrese et al. [20]10Anti-PD1: 1, anti-PD1 and anti-CTLA-4: 6NSCLC: 1, RCC: 2, melanoma: 4Seronegative arthritis: 7, PMR: 3Polyarthritis: 7Symmetrical: 6, asymmetrical: 1NoneArthritisRF: 1, anti-CCP Ab: −ve, ANA: 1Prednisone: 6, prednisone and DMARDs (HCQ, MTX, infliximab, etanercept, adalimumab): 4Prednisone (40–15 mg/day)Significant improvement: 4, moderate improvement: 4, minimal improvement: 2Held: 4, continued: 3
Belkhir et al. [26]10Anti-PD1/PD-L1: 9, anti-PD1 and anti-CTLA-4: 1Melanoma: 3, lung adenocarcinoma: 2, endometrial adenocarcinoma: 1, squamous cell carcinoma of the vagina: 1, mesothelioma: 1, colon adenocarcinoma: 1, gastric adenocarcinoma: 1RA: 6, PMR: 4NRNRNRInflammatory arthritisRF: 4, anti-CCP Ab: 6, ANA: 1Steroid: 7, NSAIDs: 1, NSAIDs and DMARDs (MTX, HCQ): 2Prednisone (20–10 mg/day) 60 mg for 1 patientImprovement: 10Continued: 9
Le Burel et al. [27]17Anti-PD1/PD-L1: 15, anti-PD1 and anti-CTLA-4: 2Melanoma: 3, RCC: 2, lung adenocarcinoma: 3, pleural mesothelioma: 1, endometrioid carcinoma: 1, colon adenocarcinoma: 1, vaginal squamous cell carcinoma: 1, lung squamous carcinoma: 1, urothelial bladder cancer: 1, glioblastoma: 1, renal epithelioid angiomyolipoma: 1, gastric adenocarcinoma: 1RA: 3, PMR: 4, psoriatic arthritis: 3, seronegative arthritis: 7Polyarthritis: 13Symmetrical: 11, asymmetrical: 1NRInflammatory arthritisRF: 3, anti-CCP Ab: 3, ANA: 1Steroids: 14, steroid and DMARDs (MTX): 2NAImprovement: 9, resolution: 7, stable: 1NA
Le Bakhaya et al. [28]26Anti-PD1: 23, anti-PD1 and anti-CTLA-4: 3Melanoma: 25, Merkel cell carcinoma: 1Arthritis: 10, activated osteoarthritis: 5, arthralgia (not specified): 11Polyarthritis: 7, oligoarthritis: 19Symmetrical: 16NRArthralgiaRF: 2, anti-CCP ab: 1, ANA: 1NSAIDs: 19, steroid: 5, DMARDs (sulfasalazine, HCQ): 2Prednisone (5–10 mg/day)Complete response: 4, partial response: 15, stable disease: 5Held: 2
Ngo et al. [29]1Anti-PD1MelanomaSeronegative arthritisPolyarthritisSymmetricalNoneInflammatory arthritisRF: −ve, anti-CCP: −ve, ANA: −veSteroidPrednisone (40 mg/day)ImprovementContinued
Haikal et al. [21]1Anti-PD1MelanomaSeronegative arthritisPolyarthritisSymmetricalNoneArthritisRF: −ve, anti-CCP: −veSteroid and DMARDs (HCQ)Low-dose steroidImprovementNR
Inamo et al. [18]3Anti-PD1: 3Lung adenocarcinoma: 1, lung squamous cell carcinoma: 1, ovarian cancer: 1Seronegative arthritis: 3Polyarthritis: 2, oligoarthritis: 1Symmetrical: 3NoneInflammatory arthritisRF: −ve, Anti-CCP Ab: −ve, ANA: −veNSAIDs: 1, opioid: 1, NSAIDs and prednisone: 1Prednisone (20 mg/day) for 1 patient onlyImprovement: 3NR
Smith and Bass [30]10Anti- PD1: 3, anti-PD-1 and anti-CTLA-4: 7Melanoma: 4, lung adenocarcinoma: 2, RCC: 1, Merkel: 1, anal cancer: 1, cervical cancer: 1RA: 3, PMR: 1, others: 6Polyarthritis: 4, oligoarthritis: 4, tenosynovitis: 2NANAInflammatory arthritisRF: NA, anti- CCP Ab: 2, ANA: 6Steroid: 6, steroid and DMARDs (HCQ, sulfasalazine, MTX, mycophenolate mofetil): 4Prednisone (20–10 mg/day)Improvement: 4, resolution: 6Held: 1
Lidar et al. [31]12Anti-PD1: 8, anti-CTLA 4: 1, anti-PD1 and anti-CTLA-4: 3Melanoma: 10, sinonasal carcinoma: 1, endometrial carcinoma: 1Seronegative arthritis: 12Polyarthritis: 10, oligoarthritis: 1, monoarthritis: 1NRNoneInflammatory arthritisRF: −ve, anti-CCP Ab: none, ANA: −veNSAIDs, steroid: 5, steroid and MTX: 2, NSAIDs, steroid, MTX: 5Prednisone (>20 mg/day)Improvement: 11, unknown: 1Held: 3, continued: 3, off therapy: 6
Kostine et al. [32]35Anti-PD1/PD-L1: 33, anti-CTLA-4: 1, anti-PD-L1 and anti-CTLA- 4: 1Melanoma: 16, lung cancer: 12, RCC: 6, Merkel cell carcinoma: 1RA: 7, PMR: 11, psoriatic arthritis: 2, others: 15Mostly polyarthritis: exact no. not reportedMostly symmetricalBack pain: 10Inflammatory and noninflammatory arthritisRF: −ve, anti-CCP Ab: 1, ANA: 4Steroid: 18, NSAIDs: 5, steroid and DMARDs (MTX): 2, intraarticular steroid: 1Prednisone (mean dose 15 mg)Improvement: 35Continued: 34
Leipe et al. [33]14Anti-PD1: 10, anti-PD1 and anti-CTLA4: 4Melanoma: 10, NSCLC: 5Arthritis: 14, PMR: 5, Sicca syndrome: 2, myositis: 1Polyarthritis: 2, oligoarthritis: 5, monoarthritis: 7NRNANew-onset arthralgia and arthritisRF: 5, anti-CCP: 1, ANA: 9Steroid: 3, steroid and DMRDs (MTX): 6, NSAIDs: 2, IA steroid: 8NRImprovement: 13Continued: 14
Narváez et al. [34]11Anti-PD1/PD-L1: 10, anti-PD1 and anti-CTLA4: 1Lymphoma: 2, lung cancer: 4, RCC: 1, epithelioid mesothelioma: 1, pancreatic neuroendocrine cancer: 1, melanoma: 1, urothelial carcinoma: 1Seronegative arthritis: 5, PMR: 1, Sicca syndrome: 2, inflammatory myositis with fasciitis: 2, paraneoplastic acral vascular syndrome: 1Polyarthritis: 4, oligoarthritis: 1Mostly symmetricalNoneArthritisRF: −ve, anti-CCP: −ve, ANA: −veSteroid: 4, NSAIDs: 1, steroid and DMARDs (HCQ): 3Prednisone (cobra light schedule): 2 patients, prednisone 60 mg daily for 1 patient and methylprednisone 20 mg daily for 1 patientImprovement: 10Continued: 6