irAEs — SCE Medical Oncology MCQ

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EasyImmunotherapy & Targeted TherapyirAEsSCE Medical Oncology

A 62-year-old woman receiving atezolizumab develops new-onset joint pain, stiffness and swelling affecting her hands, wrists and knees. Rheumatoid factor is weakly positive. Anti-CCP antibodies are negative. X-rays show no erosions. What is the most likely diagnosis?

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Correct answer: E — Immune-related inflammatory arthritis

Immune-related inflammatory arthritis is a recognised irAE with checkpoint inhibitors, presenting with polyarthralgia or frank polyarthritis. It can mimic rheumatoid arthritis (including RF positivity in some cases). Anti-CCP negativity helps distinguish from true RA. Management includes NSAIDs for grade 1, low-dose prednisolone for grade 2, and ICI interruption + higher-dose steroids for grade 3. DMARDs (methotrexate, sulfasalazine) may be needed for chronic/persistent cases. Unlike most irAEs, ICI-related arthritis may persist long after ICI cessation.

Reference: ESMO 2024 irAE Management Guidelines; Cappelli et al Ann Rheum Dis 2017