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Management of Metastatic Bone Disease · Review
Journal of Autoimmunity · September 6, 2026
Reinforces what was already believed, rather than introducing something new.
This systematic review of 37 cohort studies (882 patients) characterizes immune checkpoint inhibitor–induced arthritis as a heterogeneous condition occurring in 17.5 weeks after treatment initiation, predominantly polyarthritic, often concurrent with other immune-related adverse events, and managed primarily with glucocorticoids and conventional DMARDs. The data confirm that ICI-induced arthritis lacks standardized diagnostic criteria and remains incompletely characterized despite clearer epidemiologic and phenotypic profiling.
Systematic review and meta-analysis of cohort studies. Studies reporting cases of arthritis induced by anti-PD1, anti-PDL1, anti-CTLA4, or combinations in patients treated with immune checkpoint inhibitors.. Intervention: Exposure to immune checkpoint inhibitors (anti-PD1, anti-PDL1, anti-CTLA4, or combinations).. n = 882. Not specified; international scope implied by inclusion of studies from January 2017 to May 2024..
Median age 63.6 years (95% CI 61.9–65.2); 57.8% male; melanoma 41.3%, lung cancer 27.7% of underlying malignancies Time to onset of ICI-induced arthritis 17.5 weeks (95% CI 13.7–21.2) from treatment initiation 74.2% received anti-PD1, 6.9% anti-PDL1, 16% anti-CTLA4; 20% received combination therapy
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Rheumatologists and oncologists should recognize ICI-induced arthritis as a polyarthritic condition occurring ~4–5 months after ICI initiation, often accompanied by other immune-related adverse events, and responsive to glucocorticoids and DMARDs. The low frequency of positive autoantibodies and absence of classification criteria in 97% of cases highlight the need for clinical rather than serological diagnosis.
Systematic review with pooled analysis of 37 cohort studies characterizing ICI-induced arthritis epidemiology, phenotypes, and management; confirms and refines understanding of a known adverse event but does not establish new clinical outcomes or change practice acutely.
As stated by the source record.
Quoted from the source exactly as published.
Rheumatologists and oncologists should recognize ICI-induced arthritis as a polyarthritic condition occurring ~4–5 months after ICI initiation, often accompanied by other immune-related adverse events, and responsive to glucocorticoids and DMARDs. The low frequency of positive autoantibodies and absence of classification criteria in 97% of cases highlight the need for clinical rather than serological diagnosis.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background The growing use of immune checkpoint inhibitors (ICIs) in the oncology field along with the potential development of the so-called immune-related adverse events (irAEs) has introduced new diagnostic and therapeutic challenges for rheumatologists. Rheumatic irAEs (Rh-irAEs), particularly those involving the musculoskeletal system, are relatively common and sometimes underdiagnosed, with an estimated prevalence of up to 7% of ICIs treated patients. In this context, we conducted a systematic review and pooled analyses of cohort studies to better characterize ICIs-induced-arthritis (ICIs-IA), defining demographic and clinical features of involved patients, the temporal relationship with treatment, and therapeutic implications. Methods This systematic review was conducted in accordance with PRISMA framework and registered with the International Register of Prospective Reviews (PROSPERO) ( registration CRD420251090954 ). A systematic search was performed in two electronic databases - PubMed and Scopus - including studies published from January 1st 2017, to May 31st 2024. Eligible studies reported cases of arthritis as an adverse event induced by immune checkpoint inhibitors (ICIs), including anti-PD1, anti-PDL1, anti-CTLA4, or their combinations. The Qumseya scale was used to assess the methodological quality of the studies included in the review. The meta-analysis of age and irAEs time to onset was performed using the metamean and metamedian functions and relative packages in R, which computes pooled means and confidence intervals while accounting for between-study heterogeneity. Results We evaluated 37 studies, encompassing 882 patients with ICIs-IA. The most common underlying malignancy was melanoma (41.3%), followed by lung cancer (27.7%). Moving on treatment, 74.2% of patients received anti-PD1 drugs, 6.9% anti-PDL1, 16% anti-CTLA4; 20% of patients received a combination therapy (anti-CTLA4 plus anti-PD1). ICIs-IA patients were more frequently male (57.8% versus 42.2%), with a median age of 63.6 years (95% CI 61.9–65.2). The calculated time to onset of ICIs-IA from treatment initiation was 17.5 weeks (95% CI 13.7–21.2), ranging from 4.3 to 39.0 weeks. From a serological perspective, 7.5% of patients were positive for rheumatoid factor, 5.5% for anti-citrullinated protein antibodies and 23.4% for anti-nuclear antibodies. In terms of the clinical phenotype, 63.9% of patients experienced polyarthritis, 29.9% oligoarthritis, and 6.2% monoarthritis. Only 2.7% fulfilled classification criteria for inflammatory arthropathies or connective tissue diseases. As therapy, 67.9% of patients received glucocorticoids, 33.2% synthetic conventional DMARDs, and 11.0% biological DMARDs. Notably, ICIs-IA occurred predominantly in patients who also experienced other irAEs (64.5%). Conclusions In the absence of standardized diagnostic criteria, ICIs-induced arthritis remains a heterogeneous and incompletely characterized condition, as confirmed by our systematic review. Nevertheless, our analysis provides a more detailed characterization of this adverse event, which may facilitate earlier recognition and improved management.
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