Thursday, 24 Aug 2017

You are here

Rheumatic IRAEs Gaining Speed

Today I was fortunate to be a part of a From Bench to Bedside session on the topic of controlling the balance between cancer and autoimmunity, chaired by Drs. Leonard Calabrese and Xavier Mariette. Rheumatic IRAEs from checkpoint inhibitor therapy are growing rapidly in scope and rheumatologists must be aware of these complications, as they are certain to encounter this type of patient.

The first talk was by Dr. Antony Rosen (JHU) who discussed possible mechanisms underlying cancer in the setting of autoimmune disease, focusing on the strong associated between RNA pol III positive systemic sclerosis and the development of cancer. Next up was Dr. Aurélien Marabelle (France) who spoke from the oncology perspective on the paradigm shift in cancer therapy from drugs that target cancers to these checkpoint inhibitors that target the patient’s own immune system. He stressed the importance of interprofessional care of these patients by oncology and rheumatology.

I was thrilled to present the first abstract on our Cleveland Clinic experience with rheumatic IRAEs thus far. In our experience it seems that rheumatic IRAEs may not be self-limiting like some of the other system IRAEs (skin, gut), but rather here to stay, making the role of the rheumatologist all the more important. Dr. Rakiba Belkhir (Paris) presented the final abstract and shared a case series of 6 patients who developed ACPA-positive RA on checkpoint therapy.

Tak away points stressed that rheumatologists must become familiar with rheumatic IRAEs and engage with oncologists inter-professionally to optimize patient care, as their frequency will continue to increase.

Add new comment

More Like This

The RheumNow Week in Review – 18 August 2017

The RheumNow Week in Review discusses the past week's news, journal articles and highlights from RheumNow.com. This week's report includes new data on lupus survival, pediatric lupus guidelines from SHARE, room temperature storage of etanercept, over or under-testing by rheumatologists and failure of pain meds to treat pain.

The RheumNow Week in Review – 11 August 2017

The RheumNow Week in Review caps the week's news every Friday. Dr Jack Cush reviews the news, journal reports and important events from the past week in rheumatology.  This week's news highlights include new data on the incidence of arthritis, lag times in patient referral, criteria for referral and why/how weather change affects arthritis pain.

Criteria for Early Referrals from Primary Care

Early diagnosis and early intervention has been the mantra of all who manage musculoskeletal (MSK) diseases for decades. While the rules for referral may be clear to some, the lack of uniformity and promotion amongst primary care providers is less certain.

MSK Ultrasound Now Standard for Rheumatology Training

In the United States, musculoskeletal ultrasound (MSUS) in rheumatology has grown significantly in the last few decades. Ten years ago, more than half of rheumatology fellows had training or exposure to MSUS. A current survey of training programs shows that 94% provide MSUS training.

The RheumNow Week in Review – 4 August 2017

Dr. Jack Cush reviews new FDA decisions on sirukumab and tofacitinib as well as other news items from the past week on RheumNow.com.