Retrospective analysis of the prevalence of family history of psoriasis in patients who develop rheumatological immune-related adverse events (irAEs)


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Ionut-Gabriel Funingana1,Christine Parkinson1,Sarah Welsh1,Deniz Tafrali2,Pippa Corrie1,Anshuman Malaviya1
1Cambridge University Hospitals NHS Foundation Trust,2Medical University of Graz

Abstract

Background

Rheumatological irAEs are inconsistently reported, but the incidence varies from 1-43% patients. In non-oncology rheumatology practice, there is now recognition that family history (FH) of psoriasis is a risk factor for developing arthritis in patients and indeed, FH forms part of several diagnostic/classification criteria for arthritides. It is not known whether rheumatological FH is a risk factor for the development of rheumatological irAEs as is the case for the sporadic disease. 

Method

We undertook a single hospital retrospective analysis of patients treated with immune checkpoint inhibitors (ICIs) who developed severe musculoskeletal symptoms and were referred for rheumatological specialist review. The possible correlation between FH of psoriasis and the development of rheumatological irAEs was explored.

Results

Nine patients with grade 2/3 musculoskeletal symptoms were referred to the rheumatology service from 11/2017 to 06/2019. 7 patients received ICIs for melanoma treatment and 2 patients for renal cell cancer. The most common rheumatological manifestation was inflammatory arthritis (8/9 patients), and 1 patient developed polymyalgia rheumatica-like symptoms. In 2 patients, symptoms were managed effectively with COX2-inhibitors only, 5 required corticosteroids, while the remaining 2 patients required anti-TNF abs.  8/9 patients had an on-going complete or partial response to ICIs; one patient progressed at 6 months after the initial partial response. The 2 patients with a personal history of psoriasis developed severe rheumatological ir-AEs after only one cycle of ICIs, for one of the patients the enthesitis symptomatology settled with COX2-inhibitor only. 3 patients had a FH of psoriasis but were not themselves affected and had an on-going response to ICIs.

Conclusion

In our cohort, over half of patients experiencing moderate/severe rheumatological irAEs had a FH of psoriasis, although one third were not themselves affected. All patients with these irAEs responded well to ICIs. Further studies are needed to understand the impact of FH clinical application of irAEs.