• Jang S Yoon, Frances Zhao, Hafsa Masood, Ravini De Silva, Jessie Binns, Victoria Atkinson, Ranjeny Thomas, and Matthew Terrill.
• Department of Rheumatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
• Intern Med J. 2025 Jan 9.

BackgroundImmune checkpoint inhibitors (ICIs) have significantly improved cancer treatment outcomes but are associated with immune-related adverse events (irAEs), such as inflammatory arthritis (ir-IA). Management of ir-IA is evolving, with corticosteroids as the primary treatment, though some cases require steroid-sparing agents.AimsThis study aimed to compare initial mean prednisolone doses and disease persistence over 12 months in patients with rheumatoid arthritis (RA)-like ir-IA managed by rheumatologists or oncologists.MethodsThis retrospective observational study involved patients who developed RA-like ir-IA after ICI treatment for advanced cancers between September 2015 and January 2019 at a tertiary hospital in Brisbane, Australia. Patient records were reviewed up to January 2020 to evaluate chronicity. Data were collected, and statistical analyses compared the management between rheumatologists and oncologists.ResultsA total of 871 patients received ICI and 246 had irAEs, with 20 developing RA-like ir-IA. Nine were managed by an oncologist and 11 by a rheumatologist. The mean dose of prednisolone commenced by a rheumatologist was 14 mg compared to 53.3 mg by an oncologist (P = 0.0058). Patients managed by a rheumatologist were more likely to receive conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) (odds ratio 16, P = 0.023). Thirteen patients required ongoing maintenance treatment, while seven had resolution within 12 months of disease onset.ConclusionsRA-like ir-IA comprised 8% of ICI-related irAEs. During the study period, patients managed by rheumatologists received lower initial prednisolone doses and more frequent csDMARD than oncologists. A multidisciplinary involvement between rheumatologists and oncologists in the event of ir-IA is crucial.© 2025 Royal Australasian College of Physicians.

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