摘要 ：

        目的：探討風濕病患者接受免疫檢驗點抑製劑治療過程中風濕病複發和不良反應發生的風險。

        方法：回顧性分析了2011年至2016年700例在梅奧診所就診且同時接受免疫檢驗點抑製劑治療的患者的醫療資料。通過使用特定的診斷編碼確定這部分患者既往的風濕病種類。

        結果：共篩選出16例風濕病患者(81%女性，中位年齡為68.5歲)。其中最常見的風濕病是類風濕關節炎(5例)、風濕性多肌痛(5例)、幹燥綜合征(2例)和係統性紅斑狼瘡(2例)。7例患者在起始免疫檢驗點抑製劑治療之前即在使用免疫抑製劑或糖皮質激素治療風濕病。主要的腫瘤種類是黑色素瘤(10例)、肺部腫瘤(4例)或血液腫瘤(2例)。大部分患者都是在幾種其他抗腫瘤藥物治療失敗後開始接受免疫檢驗點抑製劑治療的。其中有6例患者出現了免疫相關性不良反應，但經過加用糖皮質激素同時停用免疫檢驗點抑製劑治療後不良反應得到了控製。出現不良反應的患者與沒有出現不良反應的患者在腫瘤診斷後起始免疫檢驗點抑製劑治療的時間、治療療程、年齡或性別方麵均無差異。

        結論：據我們所知，這是目前為止接受現代腫瘤免疫治療的最大的單中心風濕病患者群體。僅有一小部分風濕病患者出現了先前風濕病的複發或經曆了免疫相關性不良反應。

        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.