From the Guidelines
Immune-related adverse events (irAEs) associated with immune checkpoint inhibitor (ICPi) therapy can present with a variety of musculoskeletal symptoms, including arthralgia, myalgia, arthritis, polymyalgia-like syndromes, and myositis, which can significantly impact patients' quality of life (QoL) and function. The clinical presentation of these irAEs can vary, with some patients experiencing oligoarthritis of large joints, such as knees, ankles, or wrists, while others may present with symmetrical polyarthritis resembling rheumatoid arthritis 1. Patients may also develop sicca symptoms, such as dry eyes and dry mouth, and autoantibodies, such as rheumatoid factor and/or anti-citrullinated protein antibody, may be present in their sera.
Some key features of irAEs associated with ICPi therapy include:
- Musculoskeletal symptoms, such as arthralgia and myalgia, which can occur in up to 40% of patients treated with ICPi therapy 1
- Inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are usually highly elevated in patients with ICPi-induced arthritis 1
- NSAIDs alone are often not sufficient to control symptoms, and corticosteroids and synthetic or biologic disease-modifying antirheumatic drugs may be required 1
- Patients with pre-existing crystal arthritis, soft tissue rheumatic syndromes, and osteoarthritis can also flare during ICPi therapy 1
The diagnosis of irAEs associated with ICPi therapy requires a thorough clinical evaluation, including laboratory tests, such as autoantibody panels, and imaging studies, such as ultrasound or magnetic resonance imaging (MRI). It is essential to differentiate these events from other rheumatic syndromes, such as degenerative joint disease, osteoarthritis, and septic arthritis 1. Early recognition and prompt treatment of irAEs associated with ICPi therapy are crucial to improve outcomes and minimize the impact on patients' QoL.
From the Research
ARIA Clinical Presentation
- Allergic rhinitis is the most common chronic disease worldwide, with a significant impact on quality of life 2.
- The clinical presentation of allergic rhinitis can vary, but common symptoms include nasal congestion, runny nose, and itchy eyes 3.
- Rhinitis is classified into three major clinical phenotypes: allergic rhinitis (AR), infectious rhinitis, and non-allergic, non-infectious rhinitis (NAR) 3.
- ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines have improved the knowledge on rhinitis and have had a significant impact on AR management 2.
Symptoms and Diagnosis
- Total nasal symptom scores and individual nasal symptom scores are used to evaluate the severity of allergic rhinitis 4, 5.
- The Rhinoconjunctivitis Quality of Life Questionnaire is used to assess the impact of allergic rhinitis on quality of life 4, 6.
- Diagnosis of allergic rhinitis is based on a combination of clinical symptoms, medical history, and diagnostic tests such as skin prick tests and blood tests 3.
Treatment Options
- Intranasal corticosteroids and oral antihistamines are commonly used to treat allergic rhinitis, with combination therapy showing greater efficacy than monotherapy in some studies 4, 5.
- Intranasal antihistamines and corticosteroids have been shown to be effective in improving nasal and ocular symptoms and quality of life in patients with perennial or seasonal AR 6.
- ARIA care pathways for allergic rhinitis have been developed to provide guidance on diagnosis and treatment, including allergen immunotherapy 2.