We read with great interest the article ‘Addressing immune-related adverse events of cancer immunotherapy: how prepared are rheumatologists?’ by Kostine et al .1 The introduction of immune checkpoint inhibitor (ICI) therapy has been a major breakthrough in the management of metastatic cancer. On the downside, ICI therapy may induce unwanted autoimmune effects, the so-called immune-related adverse effects (irAEs). Various irAEs have been described that resemble a regular rheumatic disease, including polymyalgia rheumatica (ICI-PMR).2 3 The authors report that rheumatologists may lack confidence in diagnosing irAEs. Therefore, recommendations for the diagnosis of rheumatic irAEs are needed. Based on our experience with ICI-PMR, we propose that imaging could be an important part of such recommendations. We investigated six consecutive patients with ICI-PMR by ultrasonography, and five of these patients also by [18F]-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scan. Five patients fulfilled the provisional American College of Rheumatology/European League Against Rheumatism classification criteria for PMR.4 A normal C-reactive protein level in the absence of an erythrocyte sedimentation rate (ESR) test precluded PMR classification in one patient. However, this patient fulfilled both the clinical and ultrasound criteria for PMR,4 and showed findings suggestive of PMR on the FDG-PET/CT scan.5 The median age was 73 years (range 59–83; online supplementary table 1). Patients received anti-programmed cell death protein 1 (PD-1) treatment, that is, nivolumab or pembrolizumab. ICI therapy resulted in near-complete cancer remission (n=3) or a partial response (n=3). Following the start …

中文翻译：

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免疫检查点抑制剂诱导的风湿性多肌痛的影像学检查

我们非常感兴趣地阅读了文章“解决癌症免疫治疗的免疫相关不良事件：风湿病学家准备得如何？” 由 Kostine 等人撰写。1 免疫检查点抑制剂 (ICI) 疗法的引入是转移性癌症管理中的一项重大突破。不利的一面是，ICI 治疗可能会引起不必要的自身免疫效应，即所谓的免疫相关不良反应 (irAE)。已经描述了各种类似于常规风湿性疾病的 irAE，包括风湿性多肌痛 (ICI-PMR)。2 3 作者报告说，风湿病学家可能对诊断 irAE 缺乏信心。因此，需要对风湿性 irAE 的诊断提出建议。根据我们在 ICI-PMR 方面的经验，我们建议成像可能是此类建议的重要组成部分。我们通过超声检查连续研究了六名 ICI-PMR 患者，其中五名患者还通过 [18F]-氟脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描 (FDG-PET/CT) 扫描。五名患者符合美国风湿病学会/欧洲抗风湿病联盟对 PMR 的临时分类标准。4 在没有红细胞沉降率 (ESR) 测试的情况下，正常 C 反应蛋白水平排除了一名患者的 PMR 分类。然而，该患者符合 PMR 的临床和超声标准 4，并且在 FDG-PET/CT 扫描中显示出提示 PMR 的结果。 5 中位年龄为 73 岁（范围 59-83；在线补充表 1）。患者接受了抗程序性细胞死亡蛋白 1 (PD-1) 治疗，即纳武单抗或派姆单抗。ICI 治疗导致癌症接近完全缓解 (n=3) 或部分缓解 (n=3)。在开始之后……