Background: Immune checkpoint inhibitors (ICIs) transformed cancer treatment, producing significant survival benefits. However, ICIs can trigger toxicities called immune-related adverse events (irAEs), including inflammatory arthritis (IA) and polymyalgia rheumatica (PMR)-like syndromes. Our study aimed to systematically further characterize musculoskeletal ultrasound (MSKUS) findings in patients with ICI-IA and ICI-PMR, collectively referred to as “MSK-irAEs”, and explore the role of US in guiding treatment.Methods: The authors conducted a comprehensive chart review for patients receiving ICIs undergoing MSKUS at our center’s rheumatology clinics. US examinations were performed and reviewed by two MSKUS-certified rheumatologists. Descriptive statistics were performed to summarize demographic, clinical, and treatment-related variables. US findings were categorized with a novel scoring system: 0—no signs of inflammatory arthropathy or tendinopathy, 1—potential signs of inflammation (grayscale ≥ 2, effusion without power Doppler, synovial hypertrophy in the joint), and 2—active inflammation in joints and/or tendons (characterized by power Doppler) and signs of inflammation.Results: Twenty-three patients were included. The median age was 63 years, 52% were male, and 87% were White. Melanoma was the most common cancer (48%). MSK-irAEs were diagnosed in nineteen (83%), with MSKUS showing inflammation in seventeen (74%). Sixteen (70%) received escalation in MSK-irAE treatment after MSKUS. Four (17%) had erosive disease due to MSK-irAEs, while one had erosive osteoarthritis. Individuals with inflammatory erosive changes experienced prolonged intervals between symptom onset and MSKUS, ranging from 17 to 82 months, suggesting that erosions may reflect chronic, under-recognized inflammation. On MSK-irAE therapy, nine (47%) experienced symptomatic improvement, five (26%) achieved resolution, and in four (21%) cases, it was too early to assess the response. MSKUS detected other causes of MSK symptoms besides MSK-irAEs in several patients, allowing ICI resumption in one.Conclusions: Our study highlights the clinical utility of MSKUS not only as a diagnostic tool but also to guide therapeutic decision-making.
背景：免疫检查点抑制剂（ICIs）改变了癌症治疗格局，带来了显著的生存获益。然而，ICIs可能引发称为免疫相关不良事件（irAEs）的毒性反应，其中包括炎性关节炎（IA）和风湿性多肌痛（PMR）样综合征。本研究旨在系统性地进一步描述ICI-IA和ICI-PMR（统称为“MSK-irAEs”）患者的肌肉骨骼超声（MSKUS）表现，并探讨超声在指导治疗中的作用。 方法：作者对本中心风湿病科接受ICIs治疗并进行MSKUS检查的患者进行了全面的病历回顾。超声检查由两位具备MSKUS资质的风湿病学家执行并审阅。采用描述性统计方法总结人口统计学、临床及治疗相关变量。超声结果采用一种新的评分系统进行分类：0分——无炎性关节病或肌腱病迹象；1分——潜在炎症迹象（灰阶≥2级、无能量多普勒信号的积液、关节内滑膜增生）；2分——关节和/或肌腱存在活动性炎症（以能量多普勒信号为特征）及炎症迹象。 结果：共纳入23例患者。中位年龄63岁，52%为男性，87%为白种人。黑色素瘤是最常见的癌症类型（48%）。19例（83%）确诊为MSK-irAEs，其中17例（74%）MSKUS显示炎症表现。16例（70%）在MSKUS检查后接受了MSK-irAEs治疗的升级。4例（17%）因MSK-irAEs出现侵蚀性病变，另有1例为侵蚀性骨关节炎。出现炎性侵蚀性改变的患者从症状出现到接受MSKUS检查的时间间隔较长（17至82个月），提示侵蚀可能反映了慢性、未被充分认识的炎症过程。在接受MSK-irAE治疗后，9例（47%）症状改善，5例（26%）达到症状缓解，4例（21%）因评估时间过早尚无法判断疗效。MSKUS在数例患者中检测到MSK-irAEs以外的肌肉骨骼症状病因，其中1例因此得以恢复ICI治疗。 结论：本研究强调了MSKUS不仅作为诊断工具，更在指导治疗决策方面具有重要临床价值。
Sonographic Signatures of Immune Checkpoint Inhibitor-Associated Musculoskeletal Adverse Events
肿瘤(癌症)患者之家