Immune checkpoint inhibitor-mediated polymyalgia rheumatica versus primary polymyalgia rheumatica: Comparison of disease characteristics and treatment requirement

Olof C.B. Vermeulen, Elisabeth Brouwer, Riemer H.J.A. Slart, Maria Sandovici, Abraham Rutgers, T. Jeroen Hilterman, Birgitta Hiddinga, Sjoukje F. Oosting, Mathilde Jalving, Albert H. de Heij, Daan G. Knapen, Geke A.P. Hospers, Kornelis S.M. van der Geest*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objectives: To compare clinical characteristics, imaging findings and treatment requirements of patients with immune checkpoint inhibitor-mediated polymyalgia rheumatica (ICI-PMR) and primary PMR.
Methods: This single centre, retrospective cohort study compared ICI-PMR in patients with cancer (n = 15) to patients with primary PMR (n = 37). A comparison was made between clinical symptoms, laboratory markers, ultrasonography, 18F-FDG-PET/CT findings and treatment requirements related to PMR.
Results: Patients with ICI-PMR less frequently fulfilled the EULAR/ACR classification criteria for PMR (66.7%) than patients with primary PMR (97.3%). Morning stiffness, weight loss and elevation of the ESR were less frequently seen in patients with ICI-PMR. No differences were observed regarding the presence of inflammatory lesions on ultrasound of the shoulders and hips between the two groups. The Leuven and the Leuven/Groningen 18F-FDG-PET/CT scores were significantly lower in the ICI-PMR group. Finally, the ICI-PMR group could be managed with lower glucocorticoid doses than the primary PMR group, while this treatment could be discontinued more quickly.
Conclusion: Our findings indicate that ICI-PMR may have a milder course with less intense inflammation than primary PMR. ICI-PMR can be managed with a relatively low glucocorticoid dose. Our study underscores that ICI-PMR should be regarded as a PMR-like syndrome.
Original languageEnglish
Number of pages9
JournalRheumatology
Early online date9 Feb 2024
DOIs
Publication statusE-pub ahead of print/First online - 9 Feb 2024

Keywords

  • Immune Checkpoint Inhibitor
  • Immune Related Adverse Events
  • Immunotherapy
  • Polymyalgia Rheumatica

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