摘要 ：

        目的：探讨风湿病患者接受免疫检验点抑制剂治疗过程中风湿病复发和不良反应发生的风险。

        方法：回顾性分析了2011年至2016年700例在梅奥诊所就诊且同时接受免疫检验点抑制剂治疗的患者的医疗资料。通过使用特定的诊断编码确定这部分患者既往的风湿病种类。

        结果：共筛选出16例风湿病患者(81%女性，中位年龄为68.5岁)。其中最常见的风湿病是类风湿关节炎(5例)、风湿性多肌痛(5例)、干燥综合征(2例)和系统性红斑狼疮(2例)。7例患者在起始免疫检验点抑制剂治疗之前即在使用免疫抑制剂或糖皮质激素治疗风湿病。主要的肿瘤种类是黑色素瘤(10例)、肺部肿瘤(4例)或血液肿瘤(2例)。大部分患者都是在几种其他抗肿瘤药物治疗失败后开始接受免疫检验点抑制剂治疗的。其中有6例患者出现了免疫相关性不良反应，但经过加用糖皮质激素同时停用免疫检验点抑制剂治疗后不良反应得到了控制。出现不良反应的患者与没有出现不良反应的患者在肿瘤诊断后起始免疫检验点抑制剂治疗的时间、治疗疗程、年龄或性别方面均无差异。

        结论：据我们所知，这是目前为止接受现代肿瘤免疫治疗的最大的单中心风湿病患者群体。仅有一小部分风湿病患者出现了先前风湿病的复发或经历了免疫相关性不良反应。

        附原文：

        OBJECTIVE:To determine the risk of rheumatic disease flare and adverse effects in patients with preexisting rheumatic disease who were receiving immune checkpoint inhibitor (ICI) therapy.

        METHODS:A retrospective medical record review was performed to identify all patients who received ICI therapy at Mayo Clinic in Rochester, Minnesota between 2011 and 2016 (~700 patients). Those with a preexisting rheumatic disease were identified using specific diagnostic codes.

        RESULTS:Sixteen patients were identified (81% female, median age 68.5 years). The most common rheumatic diseases were rheumatoid arthritis (n = 5), polymyalgia rheumatica (n = 5), Sjögren's syndrome (n = 2), and systemic lupus erythematosus (n = 2). Seven patients were receiving immunosuppressive therapy or glucocorticoids for their rheumatic disease at the time of initiation of the ICI. The primary malignancies were melanoma (n = 10), pulmonary (n = 4), or hematologic (n = 2). In most cases, ICIs were offered only after failure of several other therapies. Immune-related adverse effects (IRAEs) occurred in 6 patients, and all were treated successfully with glucocorticoids and discontinuation of the ICI therapy. Therewere no significant differences in time from cancer diagnosis to immunotherapy, duration of immunotherapy, age, or sex between the patients with and thosewithout IRAEs.

        CONCLUSION:To our knowledge, this represents the largest single-center cohort of patients with rheumatic diseases who were exposed to modern cancer immunotherapy. Only aminority of these patients experienced a flare of their preexisting rheumatic disease or any other IRAE.

        引自：Richter MD,Pinkston O,Kottschade LA, et al. Brief Report: Cancer Immunotherapy in PatientsWith Preexisting Rheumatic Disease: The Mayo Clinic Experience.Arthritis Rheumatol.2018 Mar; 70(3): 356-360. doi:10.1002/art.40397. Epub 2018 Feb 6.