MRI may help differentiate checkpoint inhibitor-induced arthritis, other joint pain

Last updated: 03-03-2020

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MRI may help differentiate checkpoint inhibitor-induced arthritis, other joint pain

MRI may help differentiate checkpoint inhibitor-induced arthritis, other joint pain
February 26, 2020
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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.
“Since the approval of ipilimumab, [immune checkpoint inhibitors (ICIs)] have shown survival benefit in an increasing number of cancers,” Ananta Subedi, MD, of the NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases, and colleagues wrote. “These therapies have demonstrated that the immune system can be effectively harnessed to aid in killing cancerous cells. However, their use has also led to the emergence of immune-related adverse events, such as ICI-induced inflammatory arthritis (ICI-IIA), which has been estimated to occur in approximately 2% of patients with cancer undergoing ICI treatments.”
“Radiographic examinations are commonly performed as part of clinical evaluation; however, radiographs may not be useful during early phases of inflammatory arthritis (IA) and may only provide indirect information on synovial inflammation,” they added. “In undifferentiated IA, magnetic resonance imaging (MRI) may detect factors associated with the progression to rheumatoid arthritis. Magnetic resonance imaging findings of bone marrow edema, the combination of synovitis and erosions and tenosynovitis are significant risk factors for RA progression.”
Subedi 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.
 
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.
Source: Adobe
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.
“The findings of this case series suggest that MRI may be useful for early detection of erosive disease, as well as to help identify patients at high risk for erosive disease, and thus guide medical decision-making regarding management of ICI-IIA,” Subedi and colleagues wrote. “This study supports the role of MRI as an important tool in the assessment of ICI-induced articular symptoms.”
“A prospective study of MRI may be fruitful for understanding the pathophysiological processes and long-term clinical implications of this entity,” they added. “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.
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.
“Since the approval of ipilimumab, [immune checkpoint inhibitors (ICIs)] have shown survival benefit in an increasing number of cancers,” Ananta Subedi, MD, of the NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases, and colleagues wrote. “These therapies have demonstrated that the immune system can be effectively harnessed to aid in killing cancerous cells. However, their use has also led to the emergence of immune-related adverse events, such as ICI-induced inflammatory arthritis (ICI-IIA), which has been estimated to occur in approximately 2% of patients with cancer undergoing ICI treatments.”
“Radiographic examinations are commonly performed as part of clinical evaluation; however, radiographs may not be useful during early phases of inflammatory arthritis (IA) and may only provide indirect information on synovial inflammation,” they added. “In undifferentiated IA, magnetic resonance imaging (MRI) may detect factors associated with the progression to rheumatoid arthritis. Magnetic resonance imaging findings of bone marrow edema, the combination of synovitis and erosions and tenosynovitis are significant risk factors for RA progression.”
Subedi 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.
 
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.
Source: Adobe
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.
“The findings of this case series suggest that MRI may be useful for early detection of erosive disease, as well as to help identify patients at high risk for erosive disease, and thus guide medical decision-making regarding management of ICI-IIA,” Subedi and colleagues wrote. “This study supports the role of MRI as an important tool in the assessment of ICI-induced articular symptoms.”
“A prospective study of MRI may be fruitful for understanding the pathophysiological processes and long-term clinical implications of this entity,” they added. “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.
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