Buder-Bakhaya K, et al. - Researchers aimed at delineating PD-1 antibodies (PD1ab)-induced arthralgia in patients with metastasized cutaneous malignancies. During PD1ab treatment, arthralgia is frequent. Clinical presentation of the patients varied between synovitis of predominantly large joints, progressive osteoarthritis and arthralgia without evident joint damage. Non-steroidal anti-inflammatory drugs (NSAIDs) and/or low-dose corticosteroids could provide satisfactory results in vast majority of cases.

Methods

• Patients with metastatic cutaneous malignancies treated with pembrolizumab or nivolumab ± ipilimumab at the National Center for Tumor Diseases (Heidelberg) between 01/2013 and 09/2016 were retrospectively included.
• Researchers characterized arthralgia by laboratory diagnostics, imaging, and if indicated, rheumatologic consultation.

Results

• Arthralgia developed in 26 of 195 patients (13.3%).
• In this study, the median onset of symptoms was 100 days (7–780 days).
• Arthralgia, most frequently, involved large joints (shoulders, knees) in a predominantly symmetrical pattern.
• For rheumatoid factor and/or anti-citrullinated protein antibodies, only two patients were seropositive.
• The clinical picture of arthritis developed in ten patients; seven of them indicated synovitis in MRI or PET/CT.
• Researchers noticed inflammation in joints pre-damaged by osteoarthritis in five patients. Arthralgia could not be specified in 11 patients.
• They treated majority of patients satisfactorily with NSAIDs, 23.1% required additional low-dose corticosteroids and only 7.6% of the patients received further immunosuppressive treatment.
• A better treatment response and improved PFS and OS were observed in patients with arthralgia.