Nivolumab-Induced Arthritis

All 15 cases reported by Calabrese et al. required glucocorticoids, and three required a biological agent. Of those, 10 patients required their immunotherapy to be either permanently or temporarily discontinued.³ Given our patient’s advanced cancer, TNF inhibitors were not initiated. Methotrexate could have been an option for our patient, but he had a history of hepatitis C, and there are limited data on irAEs with methotrexate use.⁶ One of the patients reported by Calabrese et al. experienced a flare of psoriatic arthritis and was treated with apremilast with good response while remaining on immunotherapy.³ Apremilast was discussed as a potential therapy option with our patient, but unfortunately, he failed to follow up in the rheumatology clinic.

Conclusion

This case highlights an important emerging complication related to cancer immunotherapy with nivolumab, and it highlights the need for physicians to maintain a low threshold to suspect irAEs in patients on immunotherapy to achieve a timely diagnosis and initiate appropriate treatment.

Catherine Strahle, DO, is an internal medicine resident at the Department of Internal Medicine at the University of Cincinnati College of Medicine.

Nathalie E. Chalhoub, MD, is a rheumatology fellow at the Division of Immunology, Allergy and Rheumatology and an outcomes research fellow in the Internal Medicine Scholars Training for Academic Research (IMSTAR) program at the University of Cincinnati College of Medicine.

Avis Ware, MD, is a professor of medicine at the Division of Immunology, Allergy and Rheumatology at the University of Cincinnati College of Medicine, and the Rheumatology Clinical Director at University of Cincinnati Health.

Acknowledgment

The authors thank Christine L. Chhakchhuak, MD, for being part of the patient’s care and for all her efforts in coordinating the treatment plan with the patient’s oncologist.

References

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