Comparing immune-checkpoint inhibitor-mediated inflammatory arthritis to polymyalgia rheumatica: a prospective cohort study
Abstract
BACKGROUND: Immune checkpoint inhibitor (ICI)-related inflammatory arthritis occurs in approximately 6% of ICI-treated patients, and is often long-lasting. The clinical presentation is heterogeneous, and often loosely resembles either rheumatoid arthritis (ICI-IA) with peripheral presentation, or polymyalgia rheumatica (ICI-PMR) with predominant bilateral shoulder and hip pain and stiffness. Our objective was to compare clinical features, immunosuppressive treatment, and cancer outcomes between ICI-IA and ICI-PMR. METHODS: Data were extracted from the Rheumatology Adverse Events Due to Immunotherapy Observational Study multicenter prospective registry, regarding patients with rheumatologist-diagnosed ICI-IA or ICI-PMR and no preexisting primary IA/PMR. Clinical features were collected at the first visit in the registry. Multivariable logistic regression was used to compare second-line immunosuppressive drug utilization between groups. Kaplan-Meier curves were constructed to compare time of prednisone tapering to a dose of (1) 10 mg and (2) 5 mg from the baseline registry visit. Cox proportional hazard models were used to compare progression-free survival (PFS). Date of first cancer progression from arthritis onset was extracted based on documentation of imaging and/or pathology in the medical record. Patients with ICI-PMR were also compared with an independent cohort of patients with primary PMR. RESULTS: We analyzed 490 patients: 418 with ICI-IA and 72 with ICI-PMR. Compared with patients with ICI-IA, patients with ICI-PMR were older (70 vs 63 years old, p<0.001), more likely to be male (p=0.034), had shorter onset after ICI initiation (87 vs 125 days, p=0.011) and had less peripheral synovitis (15% vs 72%, p<0.001). Time to a prednisone dose of 10 and 5 mg/day was comparable between groups. Patients with ICI-IA were more likely to receive a second-line immunosuppressive drug (OR 3.51 (95% CI 1.50 to 8.21, p=0.004)). PFS was comparable between groups. Compared with primary PMR (n=189), the sex ratio was inversed in ICI-PMR, but there was a similar proportion with peripheral arthritis (15%). CONCLUSIONS: Patients with ICI-IA were more likely to require a second-line immunosuppressive drug than patients with ICI-PMR, but PFS was the same. Future therapeutic clinical trials in ICI-IA/PMR should stratify patients according to phenotype.
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BibTeX
@article{tison2026comparing,
title = {{Comparing immune-checkpoint inhibitor-mediated inflammatory arthritis to polymyalgia rheumatica: a prospective cohort study}},
author = {Alice Tison and Deanna Jannat-Khah and Laura Cappelli and Maria Suarez-Almazor and Noha Abdel-Wahab and Pankti Reid and Jeffrey Sparks and Tawnie Braaten and Alexa Meara and Cassandra Calabrese and Tamiko Katsumoto and Nilasha Ghosh and Kyle Ge and Alain Saraux and Valérie Devauchelle-Pensec and Ami Shah and Clifton Bingham and Anne Bass},
journal = {Journal for Immunotherapy of Cancer},
year = {2026},
month = may,
doi = {10.1136/jitc-2025-014641},
url = {https://hal.science/hal-05837572v1},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Comparing immune-checkpoint inhibitor-mediated inflammatory arthritis to polymyalgia rheumatica: a prospective cohort study
AU - Alice Tison
AU - Deanna Jannat-Khah
AU - Laura Cappelli
AU - Maria Suarez-Almazor
AU - Noha Abdel-Wahab
AU - Pankti Reid
AU - Jeffrey Sparks
AU - Tawnie Braaten
AU - Alexa Meara
AU - Cassandra Calabrese
AU - Tamiko Katsumoto
AU - Nilasha Ghosh
AU - Kyle Ge
AU - Alain Saraux
AU - Valérie Devauchelle-Pensec
AU - Ami Shah
AU - Clifton Bingham
AU - Anne Bass
PY - 2026
DA - 2026/05/28
JO - Journal for Immunotherapy of Cancer
DO - 10.1136/jitc-2025-014641
UR - https://hal.science/hal-05837572v1
AB - BACKGROUND: Immune checkpoint inhibitor (ICI)-related inflammatory arthritis occurs in approximately 6% of ICI-treated patients, and is often long-lasting. The clinical presentation is heterogeneous, and often loosely resembles either rheumatoid arthritis (ICI-IA) with peripheral presentation, or polymyalgia rheumatica (ICI-PMR) with predominant bilateral shoulder and hip pain and stiffness. Our objective was to compare clinical features, immunosuppressive treatment, and cancer outcomes between ICI-IA and ICI-PMR. METHODS: Data were extracted from the Rheumatology Adverse Events Due to Immunotherapy Observational Study multicenter prospective registry, regarding patients with rheumatologist-diagnosed ICI-IA or ICI-PMR and no preexisting primary IA/PMR. Clinical features were collected at the first visit in the registry. Multivariable logistic regression was used to compare second-line immunosuppressive drug utilization between groups. Kaplan-Meier curves were constructed to compare time of prednisone tapering to a dose of (1) 10 mg and (2) 5 mg from the baseline registry visit. Cox proportional hazard models were used to compare progression-free survival (PFS). Date of first cancer progression from arthritis onset was extracted based on documentation of imaging and/or pathology in the medical record. Patients with ICI-PMR were also compared with an independent cohort of patients with primary PMR. RESULTS: We analyzed 490 patients: 418 with ICI-IA and 72 with ICI-PMR. Compared with patients with ICI-IA, patients with ICI-PMR were older (70 vs 63 years old, p<0.001), more likely to be male (p=0.034), had shorter onset after ICI initiation (87 vs 125 days, p=0.011) and had less peripheral synovitis (15% vs 72%, p<0.001). Time to a prednisone dose of 10 and 5 mg/day was comparable between groups. Patients with ICI-IA were more likely to receive a second-line immunosuppressive drug (OR 3.51 (95% CI 1.50 to 8.21, p=0.004)). PFS was comparable between groups. Compared with primary PMR (n=189), the sex ratio was inversed in ICI-PMR, but there was a similar proportion with peripheral arthritis (15%). CONCLUSIONS: Patients with ICI-IA were more likely to require a second-line immunosuppressive drug than patients with ICI-PMR, but PFS was the same. Future therapeutic clinical trials in ICI-IA/PMR should stratify patients according to phenotype.
SN - 2051-1426
ER -