Comparison of immune checkpoint inhibitor-induced arthritis and reactive arthritis to inform therapeutic strategy

Anders Kirkegaard Jensen, Katerina Chatzidionysiou, Christopher Kirkegaard Torp, Anne Sofie Sørensen, Helene Broch Tenstad, Valentin S. Schäfer, Marie Kostine, Søren Jacobsen, Jan Leipe*, Tue Wenzel Kragstrup

*Corresponding author for this work

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Introduction: Immune checkpoint inhibitor-induced inflammatory arthritis (ICI-IA) is a relatively new disease entity caused by ICI agents during cancer therapy. Reactive arthritis (ReA) is a well-known disease entity caused by urogenital or gastrointestinal bacterial infection or pneumonia. In this sense, ICI-IA and ReA are both defined by a reaction to a well-specified causal event. As a result, comparing these diseases may help to determine therapeutic strategies. Methods: We compared ICI-IA and ReA with special focus on pharmacological management. Specifically regarding treatment, we conducted a literature search of studies published in the PubMed database. Inclusion criteria were studies on treatment with non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GC), or disease modifying antirheumatic drugs (DMARDs) in ICI-IA or ReA. During systematic selection, 21 studies evaluating ICI-IA and 14 studies evaluating ReA were included. Results: In ICI-IA, prospective and retrospective studies have shown effects of non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoid (GC), sulfasalazine (SSZ), methotrexate (MTX), hydroxychloroquine (HCQ) and TNFi. In ReA, retrospective studies evaluated NSAIDs and GC. A randomized controlled trial reported the effect of SSZ, and a retrospective study reported the effect of MTX and SSZ in combination with tumor necrosis factor alpha inhibition (TNFi). For both entities, small case reports show treatment effects of interleukin 6 receptor inhibition (IL-6Ri). Discussion: This literature review identified both similarities and differences regarding the pathogenesis and clinical features of ReA and ICI-IA. Studies on treatment reported effectiveness of NSAIDs, GC, MTX, SSZ and TNFi in both diseases. Further, small case reports showed effects of IL-6Ri.

Original languageEnglish
Article number112687
JournalBiomedicine and Pharmacotherapy
Number of pages9
Publication statusPublished - Apr 2022

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  • Autoimmunity
  • Cancer
  • Immune checkpoint inhibitor
  • Immune checkpoint inhibitor induced inflammatory arthritis
  • Immune related adverse events
  • Immunotherapy
  • Reactive arthritis


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