- 10/2016 – 08/2018 interferon-alpha 3 subcutaneous injections / week
- 12/2018 initiation of immunotherapy with 4 cycles of ipilimumab and pembrolizumab, followed by pembrolizumab
20 weeks after initiation of the immunotherapy the patient showed joint swelling and pain accompanied by morning stiffness of both knees. A therapy with corticosteroids was started. After an initial improvement of the symptoms and therefore the continuation of the immunotherapy, the joint effusion returned with increasing leg edemas and joint pain. After ruling out another cause of the symptoms (such as chronic heart insufficiency, thrombosis, erysipelas, bacterial joint infection) we diagnosed an immune related oligoarthritis.
Due to the corticosteroid-refractory course of the symptoms an onetime infusion with infliximab was given with a significant improvement.
Due to returning symptoms after rechallenging with immunotherapy, we decided to discontinue the therapy. Fortunately the patient is in a complete response.
In general inflammatory arthritis after immune checkpoint blockade are uncommon (0,7%-5,5%) (Buder-Bakhaya et al. Cancer Immunol., Immunother. 2018 ; Le Burel et al. Eur J. Cancer 2017), but can develop a persistence of inflammation even after cessation of immunotherapy (Calabrese, L. H. et al. Nature Reviews. Rheumatology 2018). In mild courses immunotherapy can be reinitiated. However, in this case due to the recurrence of the irAE a discontinuation was necessary.
