The use of immune checkpoint inhibitor (ICI) therapy for cancer is now a pillar of oncological therapeutics and growing, with an estimated 43.5% of all tumours falling within current labelling indications for use.1 Eventually as the accessibility to ICI therapy increases, these data have staggering implications, given that an estimated number of new cancers in Europe and the USA exceeds 5 million individuals yearly.2 As a byproduct of this tidal wave of newly exposed patients to various forms of immunotherapy with estimates that 10%–20% or more who may develop serious immune related adverse events (irAEs),3 it is inevitable that the evaluation and care of such patients will pose a challenge to existing healthcare systems and likely create a space for a new specialty to manage such. From a rheumatological perspective, let us now consider that an estimated 3%–7% of ICI exposed patients may develop inflammatory arthritis (IA),4 5 making it seem inevitable that ICI associated IA will become ever more commonplace, giving us pause to ask ourselves what our current understanding of this disorder is and how prepared we are to manage it. These irAEs are heterogeneous and appear to differ in their presentations, similarity to existing constructs of autoimmune diseases and their natural history. To help focus the discussion regarding these complications and based on the available data on IrAEs, we propose a classification of them into three main categories (box 1). Most irAEs are self-limiting in nature and while they may have lasting clinical effects such as ongoing requirement for hormone replacement therapy in some endocrinopathies, the inflammatory phase of these illnesses is largely self-limiting with few exceptions, with less than 10% requiring additional therapy after suppression with glucocorticoids.6 A second category is the development of a classical autoimmune disease in subjects who were …

中文翻译：

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癌症检查点抑制剂治疗后的慢性炎症性关节炎：改变游戏规则的意义

使用免疫检查点抑制剂 (ICI) 治疗癌症现在是肿瘤治疗的一个支柱，并且还在不断增长，估计所有肿瘤中有 43.5% 属于当前的使用适应症。 1 最终随着 ICI 治疗的可及性增加，这些数据鉴于估计欧洲和美国每年新发癌症的人数超过 500 万人，因此具有惊人的影响。 2 作为新近暴露于各种形式免疫疗法的患者浪潮的副产品，估计有 10%–20% 或更多谁可能会发生严重的免疫相关不良事件 (irAE)，3 对此类患者的评估和护理不可避免地将对现有医疗保健系统构成挑战，并可能为新的专业管理此类患者创造空间。从风湿病学的角度来看，现在让我们考虑一下，估计有 3%–7% 的 ICI 暴露患者可能会发展为炎性关节炎 (IA)，4 5 使 ICI 相关 IA 变得越来越普遍似乎不可避免，让我们停下来问问自己我们目前的理解是什么这种混乱的状况以及我们准备如何应对它。这些 irAE 是异质的，并且在它们的表现、与自身免疫疾病的现有结构及其自然史方面的相似性似乎不同。为了帮助集中讨论这些并发症，并根据 IrAE 的可用数据，我们建议将它们分为三个主要类别（框 1）。大多数 irAE 本质上是自限性的，虽然它们可能具有持久的临床影响，例如在某些内分泌疾病中持续需要激素替代疗法，