Pub Date : 2024-11-17DOI: 10.1016/j.semarthrit.2024.152596
Mariangela Salvato, Andrea Doria, Alessandro Giollo
{"title":"The overlooked epidemic: Fibromyalgia in the shadows of long COVID.","authors":"Mariangela Salvato, Andrea Doria, Alessandro Giollo","doi":"10.1016/j.semarthrit.2024.152596","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2024.152596","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":" ","pages":"152596"},"PeriodicalIF":4.6,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.semarthrit.2024.152592
Michel Gcam Mertens, Sander Mj van Kuijk, Laura Wme Beckers, Fredrick Zmudzki, Bjorn Winkens, Rob Jem Smeets
Chronic musculoskeletal pain (CMP) poses a widespread health and socioeconomic problem, being the most prevalent chronic pain condition. Interdisciplinary multimodal pain treatment (IMPT) is considered the gold standard, offering cost-effective long-term care. Unfortunately, only a subset of patients experiences clinically relevant improvements in pain, fatigue, and disability post-IMPT. Establishing a prediction model encompassing various outcome measures could enhance rehabilitation and personalized healthcare. Thus, the aim was to develop and validate a prediction model for IMPT success in patients with CMP. A prospective cohort study within routine care was performed, including patients with CMP undergoing a 10-week IMPT. Success across four outcome measures was determined: patients' recovery perspective, quality of life (physical and mental), and disability. Sixty-five demographic and candidate predictors (mainly patient reported outcome measures) were examined. Finally, 2309 patients participated, with IMPT success rates ranging from 30% to 57%. Four models incorporating 33 predictors were developed, with treatment control being the sole consistent predictor across all models. Additionally, predictors effects varied in direction in the models. All models demonstrated strong calibration, fair to good discrimination, and were internally validated (optimism-corrected AUC range 0.69-0.80). Our findings show that treatment success can be predicted using standardized patient-reported measures, exhibiting strong discriminatory power. However, predictors vary depending on the outcome, underscoring the importance of selecting the appropriate measure upfront. Clinically, these results suggest potential for patient-centered care and may contribute to the development of a scientifically sound decision tool.
{"title":"Prediction models for treatment success after an interdisciplinary multimodal pain treatment program.","authors":"Michel Gcam Mertens, Sander Mj van Kuijk, Laura Wme Beckers, Fredrick Zmudzki, Bjorn Winkens, Rob Jem Smeets","doi":"10.1016/j.semarthrit.2024.152592","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2024.152592","url":null,"abstract":"<p><p>Chronic musculoskeletal pain (CMP) poses a widespread health and socioeconomic problem, being the most prevalent chronic pain condition. Interdisciplinary multimodal pain treatment (IMPT) is considered the gold standard, offering cost-effective long-term care. Unfortunately, only a subset of patients experiences clinically relevant improvements in pain, fatigue, and disability post-IMPT. Establishing a prediction model encompassing various outcome measures could enhance rehabilitation and personalized healthcare. Thus, the aim was to develop and validate a prediction model for IMPT success in patients with CMP. A prospective cohort study within routine care was performed, including patients with CMP undergoing a 10-week IMPT. Success across four outcome measures was determined: patients' recovery perspective, quality of life (physical and mental), and disability. Sixty-five demographic and candidate predictors (mainly patient reported outcome measures) were examined. Finally, 2309 patients participated, with IMPT success rates ranging from 30% to 57%. Four models incorporating 33 predictors were developed, with treatment control being the sole consistent predictor across all models. Additionally, predictors effects varied in direction in the models. All models demonstrated strong calibration, fair to good discrimination, and were internally validated (optimism-corrected AUC range 0.69-0.80). Our findings show that treatment success can be predicted using standardized patient-reported measures, exhibiting strong discriminatory power. However, predictors vary depending on the outcome, underscoring the importance of selecting the appropriate measure upfront. Clinically, these results suggest potential for patient-centered care and may contribute to the development of a scientifically sound decision tool.</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"70 ","pages":"152592"},"PeriodicalIF":4.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/j.semarthrit.2024.152582
Laura C Cappelli
Immune checkpoint molecules like PD-1 and its ligand PD-L1 and CTLA-4 are important regulators of the immune system. Medications blocking these pathways, immune checkpoint inhibitors, have been used to treat a variety of malignancies, while drugs agonizing these pathways, like abatacept, have been used in treating autoimmune diseases. Modulation of the PD-1/PD-L1 axis has become important for rheumatologists to understand in several different clinical scenarios. Currently, PD-1 agonists are being developed for treatment of rheumatoid arthritis (RA). In addition to patients with RA being potentially treated with PD-1 agonists, patients with rheumatoid arthritis may be treated with anti-PD-1/PD-L1 immune checkpoint inhibitors if they develop cancer. Finally, patients treated with immune checkpoint inhibitors may develop de novo inflammatory arthritis and be referred to rheumatology for management. In all three scenarios, there remain many unanswered clinical and translational questions. The parallel development of therapeutics antagonizing and agonizing the PD-1/PD-L1 pathway presents a unique chance for discovery in inflammatory arthritis.
{"title":"Immune checkpoint inhibitors and rheumatoid arthritis: All roads lead to PD-1?","authors":"Laura C Cappelli","doi":"10.1016/j.semarthrit.2024.152582","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2024.152582","url":null,"abstract":"<p><p>Immune checkpoint molecules like PD-1 and its ligand PD-L1 and CTLA-4 are important regulators of the immune system. Medications blocking these pathways, immune checkpoint inhibitors, have been used to treat a variety of malignancies, while drugs agonizing these pathways, like abatacept, have been used in treating autoimmune diseases. Modulation of the PD-1/PD-L1 axis has become important for rheumatologists to understand in several different clinical scenarios. Currently, PD-1 agonists are being developed for treatment of rheumatoid arthritis (RA). In addition to patients with RA being potentially treated with PD-1 agonists, patients with rheumatoid arthritis may be treated with anti-PD-1/PD-L1 immune checkpoint inhibitors if they develop cancer. Finally, patients treated with immune checkpoint inhibitors may develop de novo inflammatory arthritis and be referred to rheumatology for management. In all three scenarios, there remain many unanswered clinical and translational questions. The parallel development of therapeutics antagonizing and agonizing the PD-1/PD-L1 pathway presents a unique chance for discovery in inflammatory arthritis.</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":" ","pages":"152582"},"PeriodicalIF":4.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-12DOI: 10.1016/j.semarthrit.2024.152577
V Michael Holers
None.
无。
{"title":"Rheumatoid arthritis prevention: We need to identify new targets for \"NextGen\" therapeutic trials.","authors":"V Michael Holers","doi":"10.1016/j.semarthrit.2024.152577","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2024.152577","url":null,"abstract":"<p><p>None.</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":" ","pages":"152577"},"PeriodicalIF":4.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-12DOI: 10.1016/j.semarthrit.2024.152581
Kathryne E Marks, Alice Horisberger, Daniel H Solomon, Deepak A Rao
.
.
{"title":"Defining immune cell phenotypes that distinguish treatment responders and non-responders in RA.","authors":"Kathryne E Marks, Alice Horisberger, Daniel H Solomon, Deepak A Rao","doi":"10.1016/j.semarthrit.2024.152581","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2024.152581","url":null,"abstract":"<p><p> .</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":" ","pages":"152581"},"PeriodicalIF":4.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-10DOI: 10.1016/j.semarthrit.2024.152578
Bryant R England
Background: Interstitial lung disease (ILD) is an extra-articular manifestation of rheumatoid arthritis (RA) that causes substantial morbidity and mortality. Effective, evidence-based strategies to screen for, and manage, RA-ILD are lacking.
Objectives: Highlight recent research advances in, and further opportunities to improve, the identification and management of RA-ILD.
Findings: The goals of RA-ILD screening are early disease detection while avoiding unnecessary testing. Such an approach requires the ability to accurate risk stratify RA patients. With only a few recognized clinical risk factors for RA-ILD, a growing body of evidence on peripheral biomarkers for RA-ILD appears well suited to support a precision medicine approach. There is a paucity of evidence to guide management after RA-ILD diagnosis. While initial trials of antifibrotics have been conducted in RA-ILD and show the potential to slow the rate of pulmonary function decline, there have been no randomized trials of immunomodulatory therapies in RA-ILD. Supporting such trials, and addressing the barriers to conducting them, is a high priority.
Conclusion: Robust characterization of peripheral biomarkers in large, RA populations is essential to inform a precision medicine approach to RA-ILD identification. Randomized trials of treatments and treatment strategies that consider the systemic nature of RA-ILD are necessary to inform evidence-based RA-ILD treatment.
背景:间质性肺病(ILD)是类风湿性关节炎(RA)的一种关节外表现,可导致严重的发病率和死亡率。目前尚缺乏有效的循证策略来筛查和管理 RA-ILD:重点介绍 RA-ILD 的最新研究进展以及进一步改善 RA-ILD 识别和管理的机会:RA-ILD筛查的目标是早期发现疾病,同时避免不必要的检查。这种方法需要对 RA 患者进行准确的风险分层。由于RA-ILD的公认临床风险因素不多,越来越多的RA-ILD外周生物标志物证据似乎非常适合支持精准医疗方法。目前还缺乏证据来指导RA-ILD确诊后的治疗。虽然在RA-ILD中进行了抗纤维化药物的初步试验,并显示出减缓肺功能下降速度的潜力,但还没有在RA-ILD中进行免疫调节疗法的随机试验。支持此类试验并解决开展试验的障碍是当务之急:结论:对大量 RA 患者的外周生物标志物进行全面鉴定,对于采用精准医学方法识别 RA-ILD 至关重要。考虑到RA-ILD的系统性,有必要对治疗方法和治疗策略进行随机试验,为RA-ILD的循证治疗提供依据。
{"title":"Rheumatoid arthritis-associated interstitial lung disease: Advancing the identification and management.","authors":"Bryant R England","doi":"10.1016/j.semarthrit.2024.152578","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2024.152578","url":null,"abstract":"<p><strong>Background: </strong>Interstitial lung disease (ILD) is an extra-articular manifestation of rheumatoid arthritis (RA) that causes substantial morbidity and mortality. Effective, evidence-based strategies to screen for, and manage, RA-ILD are lacking.</p><p><strong>Objectives: </strong>Highlight recent research advances in, and further opportunities to improve, the identification and management of RA-ILD.</p><p><strong>Findings: </strong>The goals of RA-ILD screening are early disease detection while avoiding unnecessary testing. Such an approach requires the ability to accurate risk stratify RA patients. With only a few recognized clinical risk factors for RA-ILD, a growing body of evidence on peripheral biomarkers for RA-ILD appears well suited to support a precision medicine approach. There is a paucity of evidence to guide management after RA-ILD diagnosis. While initial trials of antifibrotics have been conducted in RA-ILD and show the potential to slow the rate of pulmonary function decline, there have been no randomized trials of immunomodulatory therapies in RA-ILD. Supporting such trials, and addressing the barriers to conducting them, is a high priority.</p><p><strong>Conclusion: </strong>Robust characterization of peripheral biomarkers in large, RA populations is essential to inform a precision medicine approach to RA-ILD identification. Randomized trials of treatments and treatment strategies that consider the systemic nature of RA-ILD are necessary to inform evidence-based RA-ILD treatment.</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":" ","pages":"152578"},"PeriodicalIF":4.6,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-10DOI: 10.1016/j.semarthrit.2024.152583
Rebecca B Blank, Renuka R Nayak, Jose U Scher
{"title":"Can we modulate the gut microbiome to enhance DMARD efficacy in rheumatoid arthritis?","authors":"Rebecca B Blank, Renuka R Nayak, Jose U Scher","doi":"10.1016/j.semarthrit.2024.152583","DOIUrl":"10.1016/j.semarthrit.2024.152583","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":" ","pages":"152583"},"PeriodicalIF":4.6,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-09DOI: 10.1016/j.semarthrit.2024.152580
Ted R Mikuls, Joshua F Baker, Grant W Cannon, Bryant R England, Gail Kerr, Andreas Reimold
Background: As the largest integrated healthcare system in the U.S., the Veterans Affairs (VA) provides a unique context for the conduct of clinical and clinical-translational research in rheumatoid arthritis (RA).
Objectives: To review attributes of the VA Rheumatoid Arthritis Registry (RA) and highlight its research contributions.
Findings: With >3,600 participants enrolled from 19 VA medical centers across the U.S., VARA includes longitudinally collected clinical data and a central biorepository that includes serum, plasma, and DNA collected at enrollment. VARA research capacity is enhanced via active linkages with internal data including the VA's Corporate Data Warehouse and elements captured during oncology care. This capacity is further enabled via active linkages with the National Death Index and Centers for Medicare & Medicaid Services (CMS) data.
Conclusion: As a highly unique study population with comprehensive data annotation available to researchers, VARA is poised to continue address impactful questions in RA for years to come.
背景:作为美国最大的综合医疗保健系统,退伍军人事务部(VA)为开展类风湿关节炎(RA)的临床和临床转化研究提供了独特的环境:目的:回顾退伍军人事务部类风湿关节炎登记处(RA)的特点,并强调其在研究方面的贡献:VARA 登记了来自全美 19 个退伍军人医疗中心的超过 3,600 名参与者,包括纵向收集的临床数据和中央生物库,其中包括登记时收集的血清、血浆和 DNA。VARA 的研究能力通过与包括退伍军人事务部企业数据仓库在内的内部数据以及肿瘤治疗过程中采集的元素的主动链接而得到增强。通过与国家死亡指数(National Death Index)和医疗保险与医疗补助服务中心(CMS)数据的积极链接,VARA 的研究能力得到了进一步提升:作为一个非常独特的研究群体,研究人员可以使用全面的数据注释,VARA 将在未来数年内继续解决 RA 中具有影响力的问题。
{"title":"The Veterans Affairs Rheumatoid Arthritis Registry: A unique population in rheumatoid arthritis research.","authors":"Ted R Mikuls, Joshua F Baker, Grant W Cannon, Bryant R England, Gail Kerr, Andreas Reimold","doi":"10.1016/j.semarthrit.2024.152580","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2024.152580","url":null,"abstract":"<p><strong>Background: </strong>As the largest integrated healthcare system in the U.S., the Veterans Affairs (VA) provides a unique context for the conduct of clinical and clinical-translational research in rheumatoid arthritis (RA).</p><p><strong>Objectives: </strong>To review attributes of the VA Rheumatoid Arthritis Registry (RA) and highlight its research contributions.</p><p><strong>Findings: </strong>With >3,600 participants enrolled from 19 VA medical centers across the U.S., VARA includes longitudinally collected clinical data and a central biorepository that includes serum, plasma, and DNA collected at enrollment. VARA research capacity is enhanced via active linkages with internal data including the VA's Corporate Data Warehouse and elements captured during oncology care. This capacity is further enabled via active linkages with the National Death Index and Centers for Medicare & Medicaid Services (CMS) data.</p><p><strong>Conclusion: </strong>As a highly unique study population with comprehensive data annotation available to researchers, VARA is poised to continue address impactful questions in RA for years to come.</p>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":" ","pages":"152580"},"PeriodicalIF":4.6,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-09DOI: 10.1016/j.semarthrit.2024.152591
Katherine P Liao, Tianxi Cai
{"title":"Artificial intelligence as an assistant for studying treatment response in rheumatoid arthritis.","authors":"Katherine P Liao, Tianxi Cai","doi":"10.1016/j.semarthrit.2024.152591","DOIUrl":"https://doi.org/10.1016/j.semarthrit.2024.152591","url":null,"abstract":"","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":" ","pages":"152591"},"PeriodicalIF":4.6,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-09DOI: 10.1016/j.semarthrit.2024.152573
Mazen Nasrallah , Greg Challener , Sara Schoenfeld , Mark Matza , Donald Lawrence , Meghan J. Mooradian , Kerry L Reynolds , Ryan J. Sullivan , Minna J. Kohler
Background
Cancer immunotherapy with checkpoint inhibition (ICI) has revolutionized the treatment of solid cancers; however, it is associated with a spectrum of immune-related adverse events (irAEs), including inflammatory arthritis. Here we report our experience with the use of point-of-care musculoskeletal ultrasound (MSKUS) and provide a description of MSKUS findings in patients with definite musculoskeletal irAEs.
Methods
Patients ≥18 years who received ICI at the Mass General Cancer Center from 2010–2019 were referred to rheumatology by oncology for evaluation of musculoskeletal symptoms following ICI therapy. Fifty-five patients with suspected MSK irAEs had MSKUS performed and interpreted by the same ultrasonographer. Findings were reviewed and confirmed by a blinded US reader. US findings in patients with definite de novo MSK irAEs were reviewed and correlated with the presence or absence of documented clinical synovitis and with available synovial fluid analysis.
Results
Thirty-four out of fifty-five patients (62 %) had definite de novo irAE. Seven patients were identified with alternative etiologies assisted by diagnostic MSKUS. Twenty patients with definite de novo irAE had clinical evidence of synovitis at the time of the initial MSKUS examination, while 14 did not. Among patients with clinically evident synovitis, MSKUS examination confirmed inflammatory pathology in all patients. The most common MSKUS features identified were grade 2 or higher synovial thickening (80 %), hyperemia measured by color power Doppler (CPD) signal (70 %), and tenosynovitis (60 %). Among the 14 patients without clinically evident synovitis, inflammatory features were identified in 10 patients (71 %); the most common features identified were > grade 1 synovial proliferation, hyperemia and tenosynovitis. Of 15 patients who underwent synovial fluid analysis, 7 patients had synovial fluid cell counts < 2000 cells/µL considered traditionally within the ‘non-inflammatory’ range, and all 7 patients were noted to have inflammatory MSKUS findings.
Conclusion
Point-of-care MSKUS is a valuable tool in the evaluation of potential MSK irAEs. Our data demonstrates its ability to expediate early identification of subclinical synovitis and/or tenosynovitis even when synovial fluid analysis is within the traditional non-inflammatory range.
{"title":"Musculoskeletal ultrasound characteristics of checkpoint inhibitor-associated inflammatory arthritis","authors":"Mazen Nasrallah , Greg Challener , Sara Schoenfeld , Mark Matza , Donald Lawrence , Meghan J. Mooradian , Kerry L Reynolds , Ryan J. Sullivan , Minna J. Kohler","doi":"10.1016/j.semarthrit.2024.152573","DOIUrl":"10.1016/j.semarthrit.2024.152573","url":null,"abstract":"<div><h3>Background</h3><div>Cancer immunotherapy with checkpoint inhibition (ICI) has revolutionized the treatment of solid cancers; however, it is associated with a spectrum of immune-related adverse events (irAEs), including inflammatory arthritis. Here we report our experience with the use of point-of-care musculoskeletal ultrasound (MSKUS) and provide a description of MSKUS findings in patients with definite musculoskeletal irAEs.</div></div><div><h3>Methods</h3><div>Patients ≥18 years who received ICI at the Mass General Cancer Center from 2010–2019 were referred to rheumatology by oncology for evaluation of musculoskeletal symptoms following ICI therapy. Fifty-five patients with suspected MSK irAEs had MSKUS performed and interpreted by the same ultrasonographer. Findings were reviewed and confirmed by a blinded US reader. US findings in patients with definite de novo MSK irAEs were reviewed and correlated with the presence or absence of documented clinical synovitis and with available synovial fluid analysis.</div></div><div><h3>Results</h3><div>Thirty-four out of fifty-five patients (62 %) had definite de novo irAE. Seven patients were identified with alternative etiologies assisted by diagnostic MSKUS. Twenty patients with definite de novo irAE had clinical evidence of synovitis at the time of the initial MSKUS examination, while 14 did not. Among patients with clinically evident synovitis, MSKUS examination confirmed inflammatory pathology in all patients. The most common MSKUS features identified were grade 2 or higher synovial thickening (80 %), hyperemia measured by color power Doppler (CPD) signal (70 %), and tenosynovitis (60 %). Among the 14 patients without clinically evident synovitis, inflammatory features were identified in 10 patients (71 %); the most common features identified were > grade 1 synovial proliferation, hyperemia and tenosynovitis. Of 15 patients who underwent synovial fluid analysis, 7 patients had synovial fluid cell counts < 2000 cells/µL considered traditionally within the ‘non-inflammatory’ range, and all 7 patients were noted to have inflammatory MSKUS findings.</div></div><div><h3>Conclusion</h3><div>Point-of-care MSKUS is a valuable tool in the evaluation of potential MSK irAEs. Our data demonstrates its ability to expediate early identification of subclinical synovitis and/or tenosynovitis even when synovial fluid analysis is within the traditional non-inflammatory range.</div></div>","PeriodicalId":21715,"journal":{"name":"Seminars in arthritis and rheumatism","volume":"69 ","pages":"Article 152573"},"PeriodicalIF":4.6,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}