Yang Y, Huang XJ. Immune checkpoint inhibitor-associated arthritis in advanced pulmonary adenocarcinoma: A case report. World J Clin Cases 2022; 10(29): 10701-10707 [PMID: 36312471 DOI: 10.12998/wjcc.v10.i29.10701]
Corresponding Author of This Article
Yan Yang, MM, Associate Chief Physician, Department of Respiratory Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310000, Zhejiang Province, China. 163987@zju.edu.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 16, 2022; 10(29): 10701-10707 Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10701
Immune checkpoint inhibitor-associated arthritis in advanced pulmonary adenocarcinoma: A case report
Yan Yang, Xiao-Jie Huang
Yan Yang, Xiao-Jie Huang, Department of Respiratory Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Author contributions: Yang Y designed the study, interpreted the data, and drafted the paper; Huang XJ participated in clinical treatment and revised the manuscript; both authors approved the final version to be published.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Yang, MM, Associate Chief Physician, Department of Respiratory Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310000, Zhejiang Province, China. 163987@zju.edu.cn
Received: May 10, 2022 Peer-review started: May 10, 2022 First decision: June 27, 2022 Revised: July 16, 2022 Accepted: September 1, 2022 Article in press: September 1, 2022 Published online: October 16, 2022
Abstract
BACKGROUND
With the wide application of immune checkpoint inhibitors (ICIs) in cancer treatment, immune-related adverse events occur frequently, involving almost all organs and systems. The incidence of ICI-associated arthritis (IA) is unknown. In most cases, IA is not serious and non-lethal. Higher checkpoint inhibitor arthritis disease activity may be associated with cancer progression. Here, we report a severe case of IA with high arthritis disease activity in advanced pulmonary adenocarcinoma, causing permanent withdrawal of pembrolizumab, but the patient remained in complete remission (CR) 20 mo after the development of IA.
CASE SUMMARY
An 81-year-old smoking man was admitted to our hospital because of left chest pain for 9 mo. He was finally diagnosed with advanced pulmonary adenocarcinoma, with programmed cell death 1 ligand 1 expression of 70%. The patient responded to pembrolizumab treatment and achieved CR, but IA occurred after the 5th cycle of pembrolizumab administration. Although non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs were prescribed, arthralgia and joint swelling occurred. The symptoms of arthritis were further aggravated when immunotherapy was given again after short-term withdrawal. Clinical Disease Activity Index (CDAI) score, a traditional measure of arthritis activity, was 43. Intravenous methylprednisolone was prescribed at 20 mg/d and then tapered over the subsequent 4 wk. The symptoms of arthritis steadily improved and completely resolved 4 mo after withdrawal of pembrolizumab. A recent follow-up in June 2022 revealed satisfactory clinical recovery of arthritis and the patient remained in CR.
CONCLUSION
This case report highlights that early recognition of IA and appropriate treatment are critical to improving the outcome of both ICI-arthritis and lung cancer.
Core Tip: We report a severe case of immune checkpoint inhibitor-associated arthritis (IA) in advanced pulmonary adenocarcinoma. A recent study suggested that higher checkpoint inhibitor arthritis disease activity may be associated with cancer progression. In our case, Clinical Disease Activity Index (CDAI) score increased to as high as 43, but cancer disease remained in complete remission 20 mo after the development of IA. Whether CDAI can be a predictor of disease progression needs to be confirmed in future studies.
