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

doi:10.1093/rheumatology/keae099

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

Rheumatology (Oxford). 2024 Feb 9:keae099. doi: 10.1093/rheumatology/keae099. Online ahead of print.

Affiliations

¹ Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
² Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Faculty of Science and Technology, Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands.
⁴ Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁵ Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

PMID: 38335930
DOI: 10.1093/rheumatology/keae099

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 less glucocorticoids than the primary PMR group.

Conclusion: Our findings indicate that ICI-PMR may have a milder course with less inflammation than primary PMR on 18F-FDG-PET/CT. ICI-mediated PMR patients can be managed with a relatively low glucocorticoid dose. Our study underscores that ICI-PMR should be regarded as PMR-like syndrome.

Keywords: Immune Checkpoint Inhibitor; Immune Related Adverse Events; Immunotherapy; Polymyalgia Rheumatica.